Gestational weight gain outside the recommended ranges puts women at risk for pregnancy complications and adverse birth outcomes. Food insecurity and environmental factors including neighborhood deprivation may influence gestational weight gain. This research 1) examines the impact of neighborhood deprivation on gestational weight gain, 2) identifies if the association varies by selected maternal characteristics, 3) examines the relationship between food insecurity and gestational weight gain, 4) determines if stress mediates the relationship between food insecurity and gestational weight gain, and 5) examines whether selected maternal characteristics mediate this relationship. The research was conducted through the analysis of the Pregnancy Risk Assessment Monitoring System, the American Community Survey and Florida Vital Statistics. Bivariate analyses, logistic regression and multilevel logistic regression were conducted to examine the associations. Results indicate that neighborhood deprivation and food insecurity are important risk factors for gestational weight gain that vary by stress and maternal characteristics.

In the US, 8.4% of children are diagnosed with asthma by age 18, making asthma one of the most common chronic conditions among children. Additionally, 25% of children experience persistent wheezing by age 6, an indicator of childhood asthma. Both childhood asthma and persistent wheezing may be linked to inflammatory and immune mechanisms, which are associated with inadequate and excessive gestational weight gain. Studies investigating the relationship between gestational weight gain and offspring asthma and wheeze phenotypes are limited by self-reported gestational weight gain, early age at asthma and wheeze assessments, limited adjustment for potential confounders and no trimester-specific evaluations. Therefore, we investigated the association between total and trimester-specific gestational weight gain, offspring asthma and wheeze phenotypes among 2128 mother-child pairs in Project Viva, a prospective cohort study in eastern Massachusetts. Gestational weight gain was abstracted from medical records and self-reported prepregnancy weight, and defined both continuously and using Institute of Medicine guidelines. Offspring asthma was obtained via maternal report at approximately 7 years, while wheeze trajectories were derived via latent class mixed models based on presence of wheeze between 1 and 9 years, inclusively, via maternal report. We investigated the relationship between gestational weight gain, offspring asthma and wheeze phenotypes using multivariable regressions and predicted probabilities, adjusting for important covariates. Most women had excessive gestational weight gain (56%), while 31% had adequate gestational weight gain and 13% had inadequate gestational weight gain. Approximately 18% of children had current mid-childhood asthma, 13% had early transient wheeze and 13% had persistent wheeze. We found a non-linear association between total gestational weight gain and offspring current mid-childhood asthma. Additionally, there was a 36% decreased odds of early transient wheeze among children of mothers with excessive third trimester gestational weight gain (aOR= 0.64; 95% CI: 0.42-0.98). This study adds to the body of literature by incorporating adequate inclusion of confounders and risk factors for adjustment, as well as being the first study to evaluate the association between trimester-specific gestational weight gain, offspring asthma and wheeze phenotypes.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第23377号 / 医博第4746号 / 新制||医||1051(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 川上 浩司, 教授 近藤 尚己, 教授 万代 昌紀 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Orientador: Cristina Maria Garcia de Lima Parada / Resumo: Introdução: As alterações do sono durante a gestação são frequentes, em decorrência das modificações anatômicas e fisiológicas típicas dessa fase da vida e associam-se a diversos problemas de saúde para o binômio materno-fetal, especialmente déficit de desenvolvimento placentário, ocasionando pré-eclâmpsia e restrição de crescimento intrauterino; parto prematuro e alterações no sono do lactente. A presença de sobrepeso e/ou obesidade tem sido associada a distúrbios do sono em adultos e existe base para a hipótese de que o padrão nutricional pré- gestacional possa influir na qualidade do sono da mulher na gestação e que a má qualidade do sono, independente do estado nutricional pré-gestacional, é fator de risco para ganho de peso inadequado na gestação. Objetivo: estudar as associações entre estado nutricional pré-gestacional, ganho de peso na gravidez e qualidade do sono; construir tecnologia para autocontrole do ganho de peso na gravidez. Método: Trata-se de estudo transversal aninhado a um estudo de coorte que analisou aspectos da saúde mental de gestantes, sono e desfechos nutricionais. A coleta de dados foi realizada no período de maio de 2018 a junho de 2019 mediante entrevistas presenciais, telefônicas e consulta aos prontuários das gestantes. Utilizou-se a escala de sono Mini-sleep Questionnaire, adotando-se como ponto de corte o escore 30 para definição de distúrbio severo do sono. Calculou-se o Índice de Massa Corpórea pré-gestacional, classificando as participantes ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Sleep changes during pregnancy are frequent, due to anatomical and physiological typical changes of this stage of life and are associated with several health problems for the maternal-fetal binomial, especially deficit in placental development, causing preeclampsia and fetal growth restriction; prematurity and changes in the infant's sleep. The presence of overweight and/or obesity has been associated with sleep disorders in adults and there is a basis for the hypothesis that the pre-gestational nutritional pattern may influence the quality of sleep during pregnancy and that poor sleep quality, regardless of the pre-gestational nutritional status, is a risk factor for inadequate weight gain during pregnancy. Methods: This is a nested cohort cross-sectional study. The collection was carried out from May to December 2018 and included 210 pregnant women who participated in face-to-face and telephone interviews. The Mini-sleep Questionnaire sleep scale was used, adopting a score of 30 as the cutoff point for the definition of severe sleep disorder. The pre-gestational Body Mass Index was also calculated, classifying participants as eutrophic, underweight, overweight and obese. Bivariate analysis of the data was performed and variables associated with the level of p <0.20 were included in multivariate analysis, with a 95% confidence interval and adopting a critical p <0.05. Results: Regarding the investigated associations, there was no relationship between pre-gestat... (Complete abstract click electronic access below) / Mestre

The benefits of prenatal care (PNC) are extensively documented; however, controversy surrounds the extent to which benefits are experienced among different racial groups. Determining whether PNC influences positive birth outcomes and if advantages differ by race is pertinent to attaining positive health outcomes. The purpose of this study was to examine the relationship between gestational weight gain (GWG), low birthweight (LBW), and PNC while weighing racial differences. The theoretical foundation was the motivation-facilitation theory of PNC access. Research questions were designed to (a) determine if there was a significant association between GWG and LBW, (b) determine if PNC had a mediating role if GWG was found to be associated with LBW, and (c) determine if PNC was a mediator and if that role differed between races. A quantitative, deductive correlational analysis was carried out using a retrospective observational approach. Spearman correlation showed that the relationship between GWG and LBW was significant (rs = 0.14, p < .001). Binary logistic regression was used for analysis and showed that the overall model was significant, Ï?2(12) = 50.29, p < .001, and that maternal age, race, marital status, GWG, education, body mass index (BMI), cigarette use, and gestational diabetes significantly affected the chances of LBW. Baron and Kenny's mediation analysis supported partial mediation for American Indian or Alaskan Native and Asian or Pacific Islander races and showed that PNC was significantly associated with birthweight. Based on these findings, providers can aim to implement motivational factors to increase the facilitation and use of PNC to decrease adverse birth outcomes and increase population health.

abstract: Excessive gestational weight gain (EGWG) affects 50% of US pregnant women and may be an important contributor to obesity in both the mother and child. Novel strategies to prevent EGWG are needed to reduce the risk of adverse health outcomes for the mother and child. This dissertation presents three manuscripts that 1) propose a novel model to explain how prenatal yoga may prevent EGWG through behavioral, psychological/emotional, and physical factors, 2) test the feasibility and preliminary efficacy of a prenatal yoga intervention to prevent EGWG compared to a pregnancy education comparison group, and 3) qualitatively investigate pregnant women’s experiences participating in a prenatal yoga intervention to prevent EGWG. In manuscript two, 49 women were recruited and randomized to a 12-week prenatal yoga intervention (n=23) or a time-matched pregnancy education comparison group (n=26). A satisfaction survey was administered at post-intervention to assess feasibility outcomes (e.g., acceptability, demand). Mindfulness, emotion regulation, self-awareness, sleep quality, depression, anxiety, and perceived stress were assessed at baseline and post-intervention (12-weeks) and GWG was assessed weekly. Linear mixed models were used to analyze pre-post changes in primary (i.e., GWG during pregnancy) and secondary (i.e., mindfulness, emotion regulation, self-awareness, sleep quality, depression, anxiety, and stress) outcomes. In manuscript three, interviews were conducted with pregnant women who participated in the prenatal yoga intervention (n=13). Interview responses were summarized using an inductive approach to thematic analysis. Findings in manuscript two suggest that prenatal yoga was a feasible method to prevent EGWG with high enjoyment and satisfaction reported among participants. The average number of prenatal yoga sessions attended was 8.84 (SD = 3.85). There was no significant group differences on the rate of GWG or total GWG throughout the intervention and a significant group x time interaction effect for stress (p=.03). In manuscript three, twelve themes were identified among the data and were organized into the following categories (three themes each): 1) experiences of prenatal yoga, 2) prenatal yoga and weight, 3) barriers to prenatal yoga, and 4) facilitators of prenatal yoga. This initial evidence suggests that prenatal yoga has potential as a strategy to prevent EGWG in pregnant women. / Dissertation/Thesis / Embargo form / Doctoral Dissertation Exercise and Nutritional Sciences 2019

SAMMANFATTNING I Sverige är cirka 40 procent av alla kvinnor i fertil ålder överviktiga eller har fetma. Detta medför ökade risker för kvinnan och fostret under graviditet såsom graviditetsdiabetes, preeklampsi, kejsarsnitt, intrauterin fosterdöd och barn som föds stora för tiden. I Sverige idag finns inga riktlinjer för vad som är lämplig viktuppgång utifrån Body mass index innan graviditet. Att banta under graviditet är inget som rekommenderas, men samtidigt visar studier att en överdriven viktuppgång under graviditet ökar riskerna för viktretention efter graviditeten. Det finns otillräcklig kunskap både hos gravida kvinnor och hos vårdpersonal om vad som är lämplig viktuppgång under graviditet. En kvinna som redan innan graviditet är överviktig eller har fetma utsätter sig själv och sitt ofödda barn för ytterligare risker genom överdriven viktuppgång under graviditet. Syftet med detta arbete var att undersöka interventioners effekt på att begränsa viktuppgång hos gravida kvinnor, med övervikt eller fetma, samt om dessa interventioner påverkar kvinnan eller barnet i övrigt under graviditet och förlossning. En litteraturöversikt utfördes där 15 vetenskapliga artiklar inkluderades. Artikelsökningen genomfördes i databaserna Cinahl och Pubmed. Genom att läsa artiklarna ett flertal gånger och göra understrykningar i texten hittades mönster som svarade på arbetets syfte och frågeställningar. Utifrån detta kategoriserades fakta i artiklarna. Resultatet visade att fysisk aktivitet, kostråd och beteendestrategier kan ha effekt på att begränsa viktuppgången hos gravida kvinnor med övervikt eller fetma. Många av kvinnorna som deltog i studierna förbättrade sina matvanor. I övrigt hade dessa interventioner även till viss del positiv effekt på blodtrycket och förekomsten av graviditetsdiabetes, men resultatet är på många områden inte entydigt. Ingen tydlig effekt på att begränsa födelsevikten kunde påvisas hos barnen, men det fanns en viss begränsning av barn som föddes med en födelsevikt över 4000 gram. Livsstilinterventioner kan vara effektiva för att begränsa viktuppgången under graviditet för kvinnor med övervikt eller fetma. Vidare forskning behövs för att säkerställa att detta sker på ett säkert sätt utifrån BMI klassificering.

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O ganho de peso gestacional inadequado é considerado importante indicador para desfechos adversos na gravidez. O baixo peso pré-gestacional e/ou ganho de peso insuficiente durante a gestação resultam em maior risco de anemia e hemorragias. Por outro lado, o sobrepeso ou obesidade pré-gestacional e ganho de peso excessivo durante a gestação implicam em maior risco para desenvolvimento de diabetes gestacional, doença hipertensiva da gestação e maior retenção de peso pósparto. Objetivos: Avaliar a associação entre ganho de peso inadequado na gestação e ocorrência de anemia, insuficiência de vitamina A (IVA) e níveis pressóricos de gestantes atendidas no pré-natal na Estratégia de Saúde da Família de Cruzeiro do Sul, Acre. Métodos: Análise de dados aninhada a estudo de coorte de gestantes, atendidas no prénatal da atenção básica à saúde, na área urbana do município de Cruzeiro do Sul, Acre. Os dados socioeconômicos, demográficos, obstétricos, de assistência pré-natal, antropométricos e de estilo de vida foram coletados entre fevereiro de 2015 e janeiro de 2016. A exposição de interesse ganho de peso gestacional foi obtida pela diferença de peso avaliada entre o segundo e o terceiro trimestres gestacionais, dividida pelo número de semanas nesse intervalo e classificada em: insuficiente, adequado e excessivo segundo critérios do Institute of Medicine USA (IOM) 2009. O desfecho de interesse foi o estado nutricional no terceiro trimestre gestacional avaliado pela frequência de anemia (hemoglobina sanguínea <110 g/L), IVA (retinol sérico <1,5 mol/L) e valores de pressão arterial em mmHg. Medidas de tendência central, intervalos com 95 por cento de confiança (IC95 por cento ) e teste do qui-quadrado foram calculados com auxílio do pacote estatístico STATA 14.0, ao nível de significância de P < 0,05. Modelos de regressão de Poisson múltiplos com variância robusta foram testados para desfechos dicotômicos (anemia e insuficiência de vitamina A). A seleção inicial de variáveis independentes para ajuste múltiplo considerou critérios estatísticos (P < 0,20) e pressupostos teóricos. Resultados: No total, 458 gestantes completaram duas avaliações durante o seguimento. Destas, 72 por cento tinham menos de 30 anos e 19 por cento eram adolescentes. No início da gestação a prevalência de sobrepeso foi de 24 por cento , obesidade e baixo peso, foram semelhantes, na ordem de 7 por cento . No terceiro trimestre gestacional, 18,7 por cento das gestantes apresentaram ganho de peso insuficiente e 59,1 por cento ganho de peso excessivo. As frequências gerais de anemia, IVA e hipertensão (pressão arterial sistólica 140 mmHg e diastólica 90 mmHg) foram de 17,5 por cento , 13,4 por cento e 0,6 por cento , respectivamente. As gestantes com ganho de peso semanal insuficiente apresentaram menor frequência de anemia (8,2 por cento ) e maior ocorrência de IVA (33 por cento ) quando comparadas às gestantes com ganho de peso adequado (19,6 por cento e 11,8 por cento ) e excessivo (19,6 por cento e 19,0 por cento ), respectivamente (teste do qui-quadrado, P <0.05). As razões de prevalências (IC95 por cento ) para anemia entre gestantes com ganho de peso insuficiente e excessivo foram 0,41 (0,18-0,93) e 1,00 (0,63-1,59), respectivamente, quando comparadas às gestantes com ganho de peso adequado (após ajuste por idade, escolaridade e uso de suplementos de vitaminas e minerais). Já para IVA, a prevalência foi maior entre gestantes com ganho de peso insuficiente (2,85; IC95 por cento : 1,55-5,24) e excessivo (1,53; IC95 por cento : 0,84-2,74) quando comparadas às gestantes com ganho de peso adequado (após ajuste por idade, escolaridade e uso de suplementos de vitaminas e minerais). As gestantes com ganho de peso excessivo apresentaram valores médios de pressão arterial sistólica maiores (111,10; IC95 por cento : 109,9-112,2) quando comparadas às gestantes com ganho de peso insuficiente (107,50; IC95 por cento : 105,4-109,6) e adequado (106,20; IC95 por cento : 104,3-108,20). Conclusões: O ganho de peso semanal insuficiente ou excessivo entre segundo e terceiro trimestres gestacionais foram associados ao estado nutricional no terceiro trimestre de gestação. Estratégias visando monitoramento do ganho de peso gestacional com incentivo à alimentação saudável e prática regular de atividade física são necessárias durante toda a atenção e cuidado pré-natal / The gestational weight gain has been considered important indicator for adverse pregnancy outcomes. Low pre-gestational body weight and/or insufficient weight gain during pregnancy are associated with increased risk of anemia and bleeding. On the other hand, pre-gestational overweight or obesity and excessive weight gain during pregnancy imply a greater risk for the development of gestational diabetes, hypertensive gestational disease and greater postpartum weight retention. Objectives: To evaluate the relation between gestational weight gain and anemia, vitamina A insufficiency (VAI) and blood pressure in the third trimester of pregnancy. Methods: Data analysis nested in a cohort study of pregnant women attending prenatal care in the urban area of the city of Cruzeiro do Sul, Acre. Socioeconomic, demographic, obstetric, prenatal, anthropometric and lifestyle data were collected between February 2015 and January 2016. The main exposure \"weight gain\" was obtained by the body weight difference evaluated between the second and the third gestational trimesters, divided by the number of weeks in this interval and classified in relation to pre-gestational body weight in: insufficient, adequate and excessive according to the Institute of Medicine USA (IOM) 2009 criteria. The outcomes of interest were anemia (hemoglobin concentrations <110 g/L), VAI (serum retinol <1.5 mol/L) and blood pressure levels in mmHg. Descriptive statistical data, 95 per cent confidence intervals (95 per cent CI) and chi-square test were calculated using the software STATA 14.0, at P <0.05. Multiple Poisson regression models with robust variance were tested for dichotomous outcomes (anemia and VAI). The initial selection of independent variables for multiple fit considered statistical criteria (P <0.20) and theoretical assumptions. Results: Overall, 458 pregnant women completed two evaluations during follow-up. Of them, 72 per cent were under 30 years old and 19 per cent were teenagers. At the beginning of gestation, the prevalence of overweight was 24 per cent , obesity and low weight, were similar, around 7 per cent . In the third gestational trimester, 18.7 per cent of pregnant women presented insufficient and 59.1 per cent excessive weight gain. The general frequencies of anemia, VAI and hypertension (systolic blood pressure 140 mmHg and diastolic blood pressure 90 mmHg) were 17.5 per cent , 13.4 per cent and 0.6 per cent , respectively. Pregnant women with insufficient weekly weight gain presented a lower frequency of anemia (8.2 per cent ) and a higher occurrence of VAI (33 per cent ) when compared to pregnant women with adequate (19.6 per cent and 11.8 per cent ) and excessive weight gain (19.6 per cent and 19.0 per cent ), respectively (chi-square test, P <0.05). The prevalence ratios (95 per cent CI) for anemia among pregnant women with insufficient and excessive weight gain were 0.41 (0.18-0.93) and 1.00 (0.63-1.59), respectively, when compared to pregnant women with adequate weight gain (after adjusting for age, schooling and use of vitamin and mineral supplements). The risk for VAI was higher among pregnant women with insufficient (2.85; 95 per cent CI: 1.55-5.24) and excessive weight gain (1.53; 95 per cent CI: 0.84-2.74) when compared to pregnant women with adequate weight gain (after adjusting for age, schooling and use of vitamin and mineral supplements. Pregnant women with excessive weight gain had higher mean systolic blood pressure (111.10; 95 per cent CI: 109.9-112.2) when compared to pregnant women with insufficient (107.50; 95 per cent CI: 105.4-109.6) and appropriate weight gain (106.20; 95 per cent CI: 104.3-108.20). Conclusions: Insufficient or excessive weekly weight gain between the second and third gestational trimesters were associated with the nutritional status at the third trimester of gestation. Strategies aimed at monitoring gestational weight gain with encouragement of healthy eating and regular practice of physical activity are required throughout prenatal care