Submitted by Renata Lopes (renatasil82@gmail.com) on 2017-06-28T20:42:32Z No. of bitstreams: 1 deborahfrancogoncalves.pdf: 2366130 bytes, checksum: ce6256d8630479c2c3e6b3547808e7a1 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-08-07T21:49:09Z (GMT) No. of bitstreams: 1 deborahfrancogoncalves.pdf: 2366130 bytes, checksum: ce6256d8630479c2c3e6b3547808e7a1 (MD5) / Made available in DSpace on 2017-08-07T21:49:09Z (GMT). No. of bitstreams: 1 deborahfrancogoncalves.pdf: 2366130 bytes, checksum: ce6256d8630479c2c3e6b3547808e7a1 (MD5) Previous issue date: 2017-03-28 / FAPEMIG - Fundação de Amparo à Pesquisa do Estado de Minas Gerais / Introdução: O excesso de peso é um grave problema de saúde pública e entre as possíveis causas estão os fatores reprodutivos femininos, comuns às mulheres em fase adulta. Fatores como idade da menarca, menopausa, já ter ficado grávida, número de filhos e métodos contraceptivos podem interferir positivamente no ganho excessivo de peso, entretanto não há um consenso entre a associação desses fatores e o excesso de peso em mulheres adultas, sendo necessários mais trabalhos que ajudem a esclarecer essa relação. Objetivo: Identificar a associação entre os fatores reprodutivos e o excesso de peso em mulheres adultas. Métodos: Estudo transversal realizado em 2015, que utilizou dados coletados da pesquisa sobre saúde da mulher realizada em 2011 e 2012, em Juiz de Fora, com participação de 2018 mulheres em idade reprodutiva, de 20 a 59 anos. Foi utilizado o questionário da pesquisa, composto por informações sobre as mulheres participantes. As análises estatísticas univariada, bivariada e concordância Kappa foram realizadas no programa SPSS 14.0 e os modelos de regressão no programa Stata 11.0. Resultados e Discussão: Foi encontrada elevada prevalência de mulheres com excesso de peso (61,0%) e circunferência abdominal aumentada substancialmente (59,6%). Na análise multivariada com as variáveis reprodutivas, aquelas que apresentaram relação com o excesso de peso foram idade da menarca antes dos 12 anos, uso de contraceptivo não hormonal e ter filhos, sendo que após ajuste do modelo contraceptivo não hormonal perdeu significância. A prevalência de excesso de peso em mulheres que tiveram menarca antes dos 12 anos foi 12,4% maior do que aquelas que tiveram menarca com 12 anos ou mais de idade e a prevalência de excesso de peso em mulheres que tiveram filhos foi 58,2% maior do que as que nunca tiveram. Na análise multivariada considerando circunferência abdominal aumentada substancialmente as variáveis que mantiveram significância foram semelhantes em relação à análise com excesso de peso, sendo que as mesmas variáveis reprodutivas permaneceram significantes no fim do modelo. A análise de concordância Kappa indicou forte concordância entre IMC e circunferência abdominal, mostrando que podem ser usadas de forma combinada e complementar no diagnóstico nutricional, principalmente ao considerar fatores reprodutivos. Conclusão: O cenário encontrado mostra uma grande prevalência de excesso de peso na população estudada, com ênfase na influência dos fatores reprodutivos, que merecem atenção e monitoramento, já que são característicos da população feminina adulta. / Introduction: Overweight is a serious public health problem and among the possible causes are female reproductive factors, common to women in adulthood. Factors such as age of menarche, menopause, having become pregnant, number of children and contraceptive methods may interfere positively with excessive weight gain, however there is no consensus between the association of these factors and excess of weight in adult women, requiring more work to clarify this relationship. Objective: To identifying the association between reproductive factors and excess of weight in adult women. Methods: Cross-sectional study carried out in 2015, using data collected from the women's health survey conducted in 2011 and 2012, in the city of Juiz de Fora, with envollment of 2018 women in reproductive age, from 20 to 59 years. The research questionnaire, composed of information about the women participants, was used. Univariate, bivariate and Kappa concordance statistical analyzes were performed in the SPSS 14.0 program and the regression models in the Stata 11.0 program. Results and Discussion: It was found a high prevalence of excess of weight women (61.0%) and a substantially increased abdominal circumference (59.6%). In the multivariate analysis with the reproductive variables, those that presented relationship with the excess of weight were age of menarche before 12 years old, use of non-hormonal contraceptive and to having children, after adjustment of the non-hormonal contraceptive model, it lost significance. The prevalence of excess of weight in women who had menarche before 12 years old was 12.4% higher than those who had menarche after 12 years old and over, and the prevalence of excess of weight in women who had children was 58.2% higher than the ones that never had. In the multivariate analysis considering abdominal circumference significantly increased, the variables that remained significant were similar in relation to the excess of weight analysis, and the same reproductive variables remained significant at the end of the model. The Kappa concordance analysis indicated a strong concordance between BMI and waist circumference, showing that they can be used in a combined and complementary way in nutritional diagnosis, especially when considering reproductive factors. Conclusion: The scenario shows a high prevalence of excess of weight in the studied population, with an emphasis on the influence of reproductive factors, which deserve attention and monitoring, since they are characteristic of the adult female population.

Abstract Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting 5–15% of women of reproductive age. The syndrome is characterized by menstrual irregularities, hyperandrogenism and polycystic ovaries. Infertility is a major problem in PCOS and it can be explained partially by chronic anovulatory cycles. Excess body weight and insulin resistance are common among women with PCOS, exposing them to the most common pregnancy complication, gestational diabetes mellitus (GDM) and, later in life, to a higher risk of developing glucose metabolism disorders eventually leading to outbreak of type 2 diabetes mellitus (T2DM). However, the respective roles of the syndrome per se, excess body weight and hyperandrogenism regarding the aforementioned complications are still to be clarified. The objectives were first to determine the risks of PCOS, infertility problems and decreased fertility at age 26 in women with a history of menstrual irregularity or elevated androgen levels in adolescence (at age 16). We also aimed to clarify whether PCOS per se is associated with decreased fertility and increased incidence of miscarriage, GDM, prediabetes and T2DM. Lastly, we focused on the respective roles of excess body weight and hyperandrogenism as regards the development of GDM and impaired glucose metabolism. The study populations were derived from the prospective Northern Finland Birth Cohorts 1966 and 1986, comprising all expected births in 1966 (n = 5889 females) and 1986 (n = 4567) in the two northernmost provinces of Finland. The data was complemented with fertility rates and diagnoses of GDM and T2DM from registers held by the National Institute for Health and Welfare and The Social Insurance Institution of Finland. Menstrual irregularity or elevated androgen levels in adolescence were associated at age 26 with increased risks of PCOS and infertility problems, but not with decreased fertility rates. At the end of their reproductive life women with symptoms of PCOS were not more often childless, had had a similar incidence of miscarriages but had a smaller family size compared with healthy women, and obesity further decreased family size in this group. Excess body weight and elevated androgen levels, but not PCOS per se, were independent risk factors of GDM. The increased risk of T2DM in PCOS was mainly due to excess body weight, although both factors had a synergistic effect on the development of T2DM. / Tiivistelmä Monirakkulainen munasarjaoireyhtymä (PCOS) on yleinen naisilla esiintyvä hormonaalinen häiriö, josta kärsii 5-15% lisääntymisikäisistä naisista. Kuukautiskierron häiriöt, mieshormoniylimäärä ja monirakkulaiset munasarjat ovat ominaisia oireyhtymälle. Lapsettomuus on keskeinen ongelma oireyhtymässä, mikä johtuu osittain kroonisesta ovulaatioiden epäsäännöllisyydestä tai niiden puuttumisesta. Ylipainoa ja insuliiniresistenssiä esiintyy usein oireyhtymää sairastavilla naisilla ja ne altistavat raskausajan diabeteksen puhkeamiselle. Myöhemmällä iällä PCOS-naisilla on suurentunut riski sairastua sokeriaineenvaihdunnan häiriöihin, jotka lisäävät riskiä tyypin 2 diabeteksen (T2DM) puhkeamiselle. PCOS:n, ylipainon ja mieshormoniylimäärän itsenäiset roolit edellä mainittujen häiriöiden kehittymisessä ovat kuitenkin edelleen epäselviä. Ensimmäisenä tavoitteena oli selvittää PCOS:n, lapsettomuusongelmien ja alentuneen hedelmällisyyden riskiä 26-vuotiaana naisilla, joilla todettiin kuukautiskierron häiriö tai kohonneet mieshormonipitoisuudet nuoruusiällä (16-vuotiaana). Toiseksi selvitimme, liittyykö PCOS itsessään alentuneeseen hedelmällisyyteen sekä kohonneeseen keskenmenojen, raskausdiabeteksen, diabeteksen esiasteiden ja T2DM esiintyvyyteen. Lisäksi selvitimme ylipainon ja mieshormoniylimäärän itsenäisiä rooleja raskausdiabeteksen ja muiden sokeriaineenvaihdunnan häiriöiden kehittymisessä. Tutkimusaineistoina olivat Pohjois-Suomen syntymäkohortit 1966 (n = 5889 naista) ja 1986 (n = 4567 naista), joihin sisältyivät kaikki elävänä syntyneet lapset vuosina 1966 ja 1986 kahdesta Suomen pohjoisimmasta läänistä. Tutkimusaineistoja täydennettiin hedelmällisyyslukujen ja GDM- sekä T2DM-diagnoosien osalta Terveyden ja hyvinvoinnin laitoksen ja Kansaneläkelaitoksen ylläpitämistä rekistereistä. Nuoruusiän kuukautiskierron häiriöt ja mieshormoniylimäärä olivat yhteydessä suurentuneeseen riskiin kehittää PCOS ja kärsiä lapsettomuusongelmista, mutta näiden yhteyttä alentuneisiin hedelmällisyyslukuihin 26-vuotiaana ei todettu. PCOS-oireiset naiset eivät kärsineet lapsettomuudesta lisääntymisiän aikana verrokkinaisia enemmän ja keskenmenojen esiintyvyys ei eronnut oireisten ja terveiden naisten välillä. Oireisilla naisilla oli kuitenkin pienempi perhekoko kuin verrokeilla, ja lihavuus entisestään pienensi perhekokoa oireisilla naisilla. Ylipaino ja mieshormoniylimäärä olivat itsenäisiä riskitekijöitä raskausdiabeteksen kehittymiselle. PCOS ei ollut riskitekijä raskausdiabeteksen kehittymiselle. Kohonnut T2DM-riski PCOS:ssa johtui lähinnä ylipainosta, vaikkakin molemmat tekijät olivat itsenäisiä riskitekijöitä T2DM:n kehittymiselle.