The Effect of Preoperative Oral Carbohydrate on Breastfeeding After Cesarean Section: A Double-Blind, Randomized Controlled Clinical Trial

Delay in the initiation of breastfeeding is one of the problems of cesarean section. Its causes are insulin resistance, pain, anxiety, stress, thirst, hunger, and so on. Preoperative oral carbohydrate (OCH) reduces postoperative insulin resistance and improves postoperative recovery. The present study was conducted to evaluate the effect of preoperative oral carbohydrate on breastfeeding after cesarean section. In this double-blind randomized clinical trial, 91 pregnant women who underwent elective cesarean section were randomly assigned to preoperative OCH (Nutricia Preop; n = 45) or control group (water flavored with lemon; n = 46). The patients ingested 800 ml + 400 ml of liquid before the surgery. The time to first breastfeeding after surgery (min), the duration of breastfeeding (min), and breastfeeding frequency were measured using a questionnaire for up to 36 h after the surgery. Time to first breastfeeding after surgery was significantly shorter in the OCH group than in the control group (27.47 ± 11.51 vs. 51.96 ± 20.20 min, p<.001). The mean frequency of breastfeeding (6.14 ± 0.55 vs. 4.82 ± 0.46, p <.001) was significantly higher and the mean duration of breastfeeding (116.48 ± 19.68 vs. 82.13 ± 12.40 min, p <.001) was significantly longer in the OCH group compared with the control group in the first 36 h after the surgery. Preoperative oral carbohydrate improves breastfeeding after surgery (time to first breastfeeding, breastfeeding frequency, and breastfeeding duration). Further clinical trials and precise measurement tools are needed to assess breastfeeding to confirm these effects. The study was registered at http://www.IRCT.ir (IRCT2016072629082N1). © 2018, © 2018 Taylor & Francis Group, LLC

Quais as principais características organizacionais das empresas dos diferentes segmentos da construção civil?

Resumo Neste artigo os autores se propõem a identificar os fatores que definem as principais características organizacionais de empresas do subsetor da construção civil, localizadas em Curitiba e região metropolitana, assim como verificar as diferenças existentes entre os cinco segmentos de atividade mais relevantes desse mercado: residencial, industrial e comercial, infraestrutura, serviços especializados e construção industrializada. Para tanto, foi desenvolvida uma pesquisa exploratória e de natureza quantitativa, em nível de mestrado. O método survey foi escolhido como procedimento principal para este estudo, permitindo a obtenção de dados primários por meio da aplicação de um questionário em um grupo de 118 empresas. Esse questionário procurou identificar o perfil da organização e as características organizacionais das empresas avaliadas. Os dados foram analisados com a aplicação de técnicas multivariadas de análise fatorial e análise discriminante. A análise fatorial evidenciou as estratégias de melhoria, o comportamento do indivíduo no trabalho, a estrutura de funcionamento, a dinâmica de crescimento, o estilo de gestão, as relações interpessoais e o posicionamento da empresa perante o mercado como fatores determinantes. A análise discriminante apontou significativa homogeneidade no desenvolvimento organizacional das empresas que representam os diferentes segmentos de atividade

Multivitamin versus multivitamin-mineral supplementation and pregnancy outcomes: A single-blind randomized clinical trial

Background: Increased requirement and decreased dietary intakes of micronutrients during pregnancy might affect maternal health and pregnancy outcomes. This study was aimed to examine the effects of two types of multiple micronutrient supplementations on pregnancy outcomes in Kashan, Iran. Methods: In a randomized single-blind controlled clinical trial, 104 primigravid singleton pregnant women aged 18-30 years were randomly assigned to receive either a multivitamin (n = 51) or a multivitamin-mineral (n = 53) supplements for 20 weeks. Participants consumed supplements once a day at week 16 of gestation. Maternal anthropometric data as well as newborn's weight, height, head circumference and 5-min Apgar score were also determined. Independent samples t-test was used for comparing between-group means. Multivariate linear regression analysis was used to identify determinants of newborn's weight, height and head circumference. Results: Women taking multivitamin-mineral supplements gained marginally less weight until week 28 than those taking multivitamin supplements (weight at week 28 of gestation: 67.5 ± 11.4 vs. 71.6 ± 10.3 kg, P = 0.06). Mean body mass index at week 28 (25.8 ± 4.0 vs. 28.4 ± 3.7 kg/m2, P = 0.001) as well as at delivery (28.0 ± 3.9 vs. 30.1 ± 3.8 kg/m2, P = 0.006) was lower among women taking multivitamin-mineral supplements than those taking multivitamin supplements. Although no significant difference was seen in newborns' height and Apgar score between the two groups, mean birth weight (3.3 ± 0.4 vs. 3.1 ± 0.4 kg, P = 0.04) and head circumference (35 ± 1.4 vs. 34 ± 1.3 cm, P &lt; 0.0001) of the infants whose mothers receiving multivitamin-mineral supplements were higher than those whose mothers received multivitamins. Multivitamin-mineral use by pregnant women was a significant predictor of infants' weight (β =0.191, P = 0.03) and head circumference (β =0.907, P = 0.005). Conclusions: In conclusion, we found that birth weight and head circumference was increased in infants whose mothers received multivitamin-mineral supplements for 5 months during pregnancy compared with infants whose mothers received multivitamin supplements

The effect of DASH diet on pregnancy outcomes in gestational diabetes: A randomized controlled clinical trial

Background/Objectives:The current study was performed to investigate the effects of the Dietary Approaches to Stop Hypertension (DASH) eating plan on pregnancy outcomes in pregnant women with gestational diabetes mellitus (GDM).Subjects/Methods:This randomized controlled clinical trial was performed among 52 women diagnosed with GDM. Participants were randomly assigned to consume either the control (n=26) or the DASH diet (n=26) for 4 weeks. The control diet was designed to contain 45-55 carbohydrates, 15-20 protein and 25-30 total fat. The DASH diet was rich in fruits, vegetables, whole grains and low-fat dairy products, and contained lower amounts of saturated fats, cholesterol and refined grains with a total of 2400 mg/day sodium. The numbers of women who commenced insulin therapy after dietary intervention, the mode of delivery and prevalence of polyhydramnios were assessed. The length, weight and head circumference of infants were measured during the first 24 h after birth.Results:Whereas 46.2 of women in the DASH diet needed to have a cesarean section, this percentage for the control group was 80.8 (P=0.01). The percentage of those who needed to commence insulin therapy after intervention was also significantly different between the two groups (23 for DASH vs 73 for control group, P<0.0001). Infants born to mothers on the DASH diet had significantly lower weight (3222.7 vs 3818.8 g, P<0.0001), head circumference (34.2 vs 35.1 cm, P=0.01) and ponderal index (2.50 vs 2.87 kg/m 3, P<0.0001) compared with those born to mothers on the control diet.Conclusions:In conclusion, consumption of DASH diet for 4 weeks among pregnant women with GDM resulted in improved pregnancy outcomes. © 2014 Macmillan Publishers Limited

A randomized controlled clinical trial investigating the effect of calcium supplement plus low-dose aspirin on hs-CRP, oxidative stress and insulin resistance in pregnant women at risk for pre-eclampsia

Increased levels of pro-inflammatory factors, markers of oxidative stress and insulin resistance during pregnancy have been associated with the development of pre-eclampsia. There is some evidence to suggest that calcium supplement and aspirin can reduce the risk of the disorder. To our knowledge, no reports are available indicating the effects of consumed calcium supplement plus aspirin on high sensitivity C-reactive protein (hs-CRP), oxidative stress parameters and insulin resistance in pregnant women at risk for pre-eclampsia. This study was designed to investigate the effects of consumed calcium supplement plus low-dose aspirin on hs-CRP, oxidative stress parameters and insulin resistance among Iranian pregnant women at risk for pre-eclampsia. This randomized single-blind controlled clinical trial was carried out among 42 pregnant women at risk for pre-eclampsia, primigravida, aged 18-40 year old who were carrying singleton pregnancy at their third trimester. Subjects were randomly assigned to received either the placebo (n = 22) or calcium supplement plus low-dose aspirin (n = 20) for 9 weeks. Calcium supplement plus low-dose aspirin were containing 500 mg carbonate calcium plus 80 mg aspirin. Fasting blood samples were taken at baseline and after 9 weeks intervention to measure serum hs-CRP, oxidative stress parameters including plasma Total Antioxidant Capacity (TAC) and Total Glutathione (GSH), Fasting Plasma Glucose (FPG), serum insulin and HOMA-IR score. Consumption of calcium supplement plus low-dose aspirin resulted in a significant difference serum hs-CRP levels as compared to the placebo (102.87 vs. 3227.75 ng mL-1, p = 0.01). Also, mean changes for plasma TAC (68.96 vs. -74.46 mmol L-1, p = 0.04) and total GSH levels (304.33 vs. -39.33 μmol L-1, p = 0.03) were significantly different between the two groups. No significant differences were found comparing calcium supplement plus low-dose aspirin and placebo in terms of their effects on FPG, serum insulin levels and HOMA-IR. Within-group differences in the placebo group revealed a significant increase in serum hs-CRP levels (3227.75 ng mL-1, p = 0.008) and marginally significant increase in plasma total GSH levels (304.33 μmol L-1, p = 0.07). In conclusion, consumption calcium supplement plus low-dose aspirin during pregnancy for 9 weeks in pregnant women at risk for pre-eclampsia resulted in a significant difference serum hs-CRP and increased levels of plasma TAC and total GSH as compared to the placebo group, but could not affect serum insulin levels and HOMA-IR score. © 2012 Asian Network for Scientific Information

Effect of multivitamin-mineral versus multivitamin supplementation on maternal, newborns' biochemical indicators and birth size: A double-blind randomized clinical trial

Objective: Micronutrient deficiency during pregnancy is associated with several complications. This study was designed to determine the effects of received multivitamin-mineral vs. multivitamin supplements on maternal, newborns' biochemical indicators, and birth size. Methods: This double-blind randomized-controlled clinical trial was conducted among 48 Iranian pregnant women, primigravida, aged 18-35 years old in their second and third trimester from December 2011 to September 2012. Subjects were randomly assigned to receive either the multivitamin-mineral (n=24) or multivitamin supplements (n=24) for 20 weeks. Fasting blood samples were taken at baseline and after a 20-week intervention of pregnant women as well as umbilical cord blood of the babies immediately after delivery to measure serum calcium, vitamin D, iron, magnesium, zinc and biomarkers of oxidative stress including plasma total antioxidant capacity and total glutathione. Results: Multivitamin-mineral compared to multivitamin supplementation resulted in a significant increase in maternal serum calcium (0.5 vs. -0.1 mg/dL, p=0.04) and magnesium levels (0.1 vs. -0.2 mg/dL, p<0.001). Furthermore, mean plasma total glutathione levels (1791 ± 566 vs. 1434 ± 622 μmol/l, p=0.04) of the newborns whose mothers received multivitamin-mineral were higher than those whose mothers received multivitamin supplements. Conclusions: Overall, multivitamin-mineral compared to multivitamin supplementation for 20 weeks during pregnancy resulted in a significant increase in maternal serum calcium and magnesium levels as well as a significant elevation of newborn plasma total glutathione levels. © OMSB, 2014

Favourable effects of the Dietary Approaches to Stop Hypertension diet on glucose tolerance and lipid profiles in gestational diabetes: A randomised clinical trial

Although gestational diabetes mellitus (GDM) is associated with an increased risk of maternal and neonatal morbidity, there is no consensus as to the optimal approach of nutritional management in these patients. The present study was designed to assess the effect of the Dietary Approaches to Stop Hypertension (DASH) eating plan on glucose tolerance and lipid profiles of pregnant women with GDM. The present randomised controlled clinical trial was performed among thirty-four women diagnosed with GDM at 24-28 weeks of gestation. Subjects were randomly assigned to consume either the control diet (n 17) or the DASH eating pattern (n 17) for 4 weeks. The control diet was designed to contain 45-55 carbohydrates, 15-20 protein and 25-30 total fat. The macronutrient composition of the DASH diet was similar to the control diet; however, the DASH diet was rich in fruits, vegetables, whole grains and low-fat dairy products, and contained lower amounts of saturated fats, cholesterol and refined grains with a total of 2400 mg Na/d. Fasting blood samples were taken at baseline and after 4 weeks of intervention to measure fasting plasma glucose, glycated Hb (HbA1c) and lipid profiles. Participants underwent a 3 h oral glucose tolerance tests and blood samples were collected at 60, 120 and 180 min to measure plasma glucose levels. Adherence to the DASH eating pattern, compared with the control diet, resulted in improved glucose tolerance such that plasma glucose levels reduced at 60 ( - 1·86 v. - 0·45 mmol/l, P group= 0·02), 120 ( - 2·3 v. 0·2 mmol/l, P group= 0·001) and 180 min ( - 1·7 v. 0·22 mmol/l, P group= 0·002) after the glucose load. Decreased HbA1c levels ( - 0·2 v. 0·05 , P group= 0·001) was also seen in the DASH group compared with the control group. Mean changes for serum total ( - 0·42 v. 0·31 mmol/l, P group= 0·01) and LDL-cholesterol ( - 0·47 v. 0·22 mmol/l, P group= 0·005), TAG ( - 0·17 v. 0·34 mmol/l, P group= 0·01) and total:HDL-cholesterol ratio ( - 0·6 (sd 0·9) v. 0·3 (sd 0·8), P group= 0·008) were significantly different between the two diets. Additionally, consumption of the DASH diet favourably influenced systolic blood pressure ( - 2·6 v. 1·7 mmHg, P group= 0·001). Mean changes of fasting plasma glucose ( - 0·29 v. 0·15 mmol/l, P group= 0·09) were non-significant comparing the DASH diet with the control diet. In conclusion, consumption of the DASH eating pattern for 4 weeks among pregnant women with GDM resulted in beneficial effects on glucose tolerance and lipid profiles compared with the control diet. Copyright © 2012 The Authors

Vitamin D supplementation affects serum high-sensitivity C-reactive protein, insulin resistance, and biomarkers of oxidative stress in pregnant women

Unfavorable metabolic profiles and oxidative stress in pregnancy are associated with several complications. This study was conducted to determine the effects of vitamin D supplementation on serum concentrations of high-sensitivity C-reactive protein (hs-CRP), metabolic profiles, and biomarkers of oxidative stress in healthy pregnant women. This randomized, double-blind, placebo-controlled clinical trial was conducted in 48 pregnant women aged 18-40 y old at 25 wk of gestation. Participants were randomly assigned to receive either 400 IU/d cholecalciferol supplements (n = 24) or placebo (n = 24) for 9 wk. Fasting blood samples were taken at study baseline and after 9 wk of intervention to quantify serum concentrations of hs-CRP, lipid concentrations, insulin, and biomarkers of oxidative stress. After 9 wk of intervention, the increases in serum 25-hydroxyvitamin D and calcium concentrations were greater in the vitamin D group (+3.7 μg/L and +0.20 mg/dL, respectively) than in the placebo group (-1.2 μg/L and 20.12 mg/dL, respectively; P < 0.001 for both). Vitamin D supplementation resulted in a significant decrease in serum hs-CRP (vitamin D vs. placebo groups: -1.41 vs. +1.50 μg/mL; P-interaction = 0.01) and insulin concentrations (vitamin D vs. placebo groups: -1.0 vs. +2.6 μIU/mL; P-interaction = 0.04) and a significant increase in the Quantitative Insulin Sensitivity Check Index score (vitamin D vs. placebo groups: +0.02 vs. -0.02; P-interaction = 0.006), plasma total antioxidant capacity (vitamin D vs. placebo groups: +152 vs. -20 mmol/L; P-interaction = 0.002), and total glutathione concentrations (vitamin D vs. placebo groups: +205 vs. -32 μmol/L; Pinteraction = 0.02) compared with placebo. Intake of vitamin D supplements led to a significant decrease in fasting plasma glucose (vitamin D vs. placebo groups: -0.65 vs.20.12mmol/L; P-interaction = 0.01), systolic blood pressure (vitamin D vs. placebo groups: -0.2 vs. +5.5 mm Hg; P-interaction = 0.01), and diastolic blood pressure (vitamin D vs. placebo groups: -0.4 vs. +3.1 mm Hg; P-interaction = 0.01) compared with placebo. In conclusion, vitamin D supplementation for 9 wk among pregnant women has beneficial effects on metabolic status. © 2013 American Society for Nutrition

Effect of calcium-vitamin D supplementation on metabolic profiles in pregnant women at risk for pre-eclampsia: A randomized placebo-controlled trial

Increased metabolic profiles during pregnancy are associated with an increased risk of maternal and neonatal morbidity and remain a significant medical challenge. To our knowledge, no reports are available indicating the effects of calcium-vitamin D supplementation on metabolic profiles among pregnant women at risk for pre-eclampsia. This study was designed to determine the effects of consumption calcium-vitamin D supplements on metabolic profiles among Iranian pregnant women at risk for pre-eclampsia. This randomized single-blind controlled clinical trial was performed among 49 pregnant women at risk for pre-eclampsia, primigravida, aged 18-35 year old who were carrying singleton pregnancy at their third trimester. Subjects were randomly assigned to consume the placebo (n = 25) or calcium-vitamin D supplements (n = 24) for 9 weeks. Calcium-vitamin D supplements were containing 500 mg carbonate calcium plus 200 IU vitamin D3. Fasting blood samples were taken at baseline and after 9 week intervention to measures of Fasting Plasma Glucose (FPG) and serum lipid profiles. Consumption of calcium-vitamin D supplements resulted in decreased FPG and serum triglycerides levels as compared to the placebo (-9.1 vs. 0.5 mg dL-1; p = 0.03, -11.7 vs. 49.9 mg dL-1; p = 0.001, respectively). No significant differences were found comparing calcium-vitamin D supplements and the placebo in terms of their effect on serum total-, HDL-, LDL-cholesterol levels. Within-group differences in the placebo group revealed a significant increase in serum triglycerides levels (+49.9 mg dL-1, p&lt;0.0001). In conclusion, consumption of calcium-vitamin D supplements for 9 weeks during pregnancy among pregnant women at risk for pre-eclampsia resulted in decreased FPG and serum triglycerides levels as compared to the placebo group, but could not affect serum total-, HDL-, LDL-cholesterol levels. © 2012 Asian Network for Scientific Information

Effect of daily consumption of probiotic yoghurt on lipid profiles in pregnant women: A randomized controlled clinical trial

Background: Due to enhanced fat storage primarily during the mid-pregnancy period, pregnancy is associated with elevated levels of lipid profiles. To our knowledge, no reports are available indicating the effects of probiotic yoghurt consumption on serum lipid profiles in pregnant women. Objective: This study was designed to determine the effects of daily consumption of probiotic yoghurt on lipid profiles of Iranian pregnant women. Methods: This randomized single-blinded controlled clinical trial was performed among 70 pregnant women, primigravida, aged 1830 years old who were carrying singleton pregnancy at their third trimester. Subjects were randomly assigned to consume 200g/d of conventional (n33) or the probiotic group (n37) for 9 weeks. The probiotic yoghurt was a commercially available product prepared with the starter cultures of Streptococcus thermophilus and Lactobacillus bulgaricus, enriched with probiotic culture of two strains of lactobacilli (Lactobacillus acidophilus LA5) and bifidobacteria (Bifidobacterium animalis BB12) with a total of min 1�107 colony-forming units. The conventional yoghurt contained the starter cultures of S. thermophilus and L. bulgaricus. Fasting blood samples were taken at baseline and after 9-weeks intervention to measure serum lipid profiles. Results: Although consumption of probiotic yogurt for 9 weeks had been resulted in a significant reduction in serum total-(-53.7mg/dL, p0.001), LDL-(-35.2mg/dL, p0.006) and HDL-cholesterol levels (-9.8mg/dL, p0.002) as well as serum triglyceride concentrations (-42.8mg/dL, p0.029), no significant differences were found comparing probiotic and conventional yogurts in terms of their effect on serum lipid profiles. Within-Group differences in conventional yogurt group revealed a significant reduction in HDL-cholesterol levels (-8.4mg/dL, p0.005) and borderline significant reduction in serum total cholesterol concentrations (-21.6mg/dL, p0.08). Conclusion: In conclusion, consumption of probiotic yogurt among pregnant women could not affect serum lipid profiles as compared to the conventional yogurt. © 2012 Informa UK, Ltd