Submitted by Maike Costa (maiksebas@gmail.com) on 2017-09-06T13:39:22Z No. of bitstreams: 1 arquivototal.pdf: 1210497 bytes, checksum: 5ff208589c9b231bd6d78cd27745e0d7 (MD5) / Made available in DSpace on 2017-09-06T13:39:22Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 1210497 bytes, checksum: 5ff208589c9b231bd6d78cd27745e0d7 (MD5) Previous issue date: 2016-03-18 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / The essential fatty acids are important lipids for formation of the central nervous system. During pregnancy and lactation the intake need is increased to further development of this system. The conjugated linoleic acid (CLA) is a fatty acid consisting of isomers of linoleic acid. The CLA is naturally produced by ruminant animals and is found in food products such as milk fat and meat of these animals. The CLA has been widely investigated because of its many beneficial health effects, however the effects of CLA on isolated CNS changes at this stage of life have not yet been investigated. This study aims to investigate the impact of maternal diet with different concentrations of CLA during pregnancy and lactation on the neonatal reflex maturation and cognitive function in rats. To this end, three groups were formed: the control group (GC) received a standard diet without added CLA; The GCLA1 group received the experimental diet containing 1% CLA and GCLA3 containing 3% CLA. After birth, the reflex responses were surveyed between 1 and 21 postnatal day, as well as the measurement of head size and body weight. At 42 days old, the animals participated in the habituation to the open field test, the second exposure occured after 7 days. For the evaluation of declarative memory, it was performed for object recognition test 3 days after the habituation test using the open field. After the test the animals were anesthetized and euthanized by cardiac puncture. The analyzes were compared by one way ANOVA test followed by the Holm Sidak test, considering significant difference for p <0.05. We used the Sigma start program for data analysis. The GCLA 1 and GCA3 showed acceleration in reflex maturation of puppies for most of the evaluated parameters. Body weight was higher compared to the control group (p <0.05). To assess the extent of the head, it can be seen that the GCLA1 and GCLA3 presented in laterolateral size measurements when compared to controls. In the anteroposterior extent GCLA1 and GCA3 shown to be lower when compared to the control group on day 1, with an increase in the perimeter evaluated in GCLA3 to compare it GCLA1 on the 7th and 21th day (p <0.05). On habituation in the open field test just wandered GCLA3 least the second open field indicating exposure to facilitating memory (p <0.05). In the long term object recognition test, a significant difference when comparing the time of exploration of familiar object to the time of operation of the new object occured in the GC, GCLA1 and GCLA3. Moreover, with respect to the explored ratio of the objects in GCLA1 there was a significant increase compared to GC and GCLA3 compared with GCLA1 (p <0.05). Maternal treatment with CLA anticipates reflex maturation, increases body weight, head size and improves responses in memory tests in the offspring of rats. / Os ácidos graxos essenciais são lipídios muito importantes para a formação do sistema nervoso central (SNC). Durante a gestação e lactação sua necessidade encontra-se aumentada para melhor desenvolvimento deste sistema. O Ácido Linoleico Conjugado (CLA) é um ácido graxo formado por isômeros de ácido linoleico. Este ácido graxo vem sendo investigado devido aos seus prováveis efeitos benéficos à saúde, porém os efeitos da mistura de CLA sobre alterações do SNC durante a fase de gestação e lactação ainda não foram investigados. Assim, este estudo tem como objetivo investigar o impacto de dieta materna com diferentes concentrações de CLA durante a gestação e lactação sobre a maturação reflexa neonatal e função cognitiva em ratos. Para tanto, foram formados 3 grupos: O Grupo Controle (GC) recebeu a dieta padrão sem adição de CLA; O Grupo GCLA1, a dieta experimental contendo 1% de CLA e o GCLA3, contendo 3% de CLA. Após o nascimento, as respostas reflexas foram avaliadas entre o 1º e 21º dia pós-natal, como também a aferição do tamanho da cabeça e o peso corporal. Aos 42 dias de vida, os animais participaram do teste de habituação ao campo aberto, sendo a segunda exposição após 7 dias. Para a avaliação da memória declarativa, foi realizado o teste de reconhecimento de objetos 7 dias após o teste de habituação, usando o campo aberto. Após os testes os animais foram anestesiados e eutanasiados por punção cardíaca. Os dados foram analisados pelo teste One Way ANOVA seguidas pelo teste de Tukey para os dados paramétricos e o teste Kruskal Wallis para os dados não paramétricos, considerando-se diferença significativa para p < 0,05. Utilizou-se o programa Sigma Start para a análise dos dados. Os GCLA 1 e GCA3 mostraram aceleração na maturação reflexa de filhotes para a maioria dos parâmetros avaliados. O peso corporal foi mais elevado em comparação com o grupo de controlo (p <0,05). Ao avaliar a medida da cabeça, podese observar que o GCLA1 e o GCLA3 apresentaram maior tamanho nas medidas laterolateral quando comparado ao controle. Já na medida anteroposterior o GCLA1 e GCLA3 mostraram-se menor quando comparado ao GC no 1º dia, havendo um aumento no perímetro avaliado no GCLA3 ao compara-lo GCLA1 no 7º e 21º dia (p<0,05). No teste de habituação no campo aberto apenas o GCLA3 deambulou menos na segunda exposição ao campo aberto indicando facilitação da memória (p<0,05). No teste de reconhecimento de objetos a longo prazo, houve diferença estatística significativa quando comparado o tempo de exploração do objeto familiar ao tempo de exploração do objeto novo nos GC, GCLA1 e GCLA3. Além disso, com relação à taxa de exploração dos objetos, no GCLA1 essa diferença foi observada quando comparado ao GC, e o GCLA3 ao GCLA1 (p<0,05). O tratamento materno com CLA antecipa maturação reflexa, aumenta o peso corporal, tamanho da cabeça e melhora respostas em testes de memória na prole de ratas.

Introdução: O ganho de peso gestacional é um indicador de saúde materno-fetal, estando associado com duração da gestação, tipo de parto, peso do bebê ao nascer e retenção de peso materno pós-parto, cujos determinantes podem ser o estado nutricional prégestacional, o consumo alimentar e os fatores sociais. Objetivos: Descrever o ganho de peso total de gestantes atendidas em unidades básicas de saúde e sua associação com o estado nutricional pré-gestacional, com fatores sóciodemográficos e relacionados à gestação. Delineamento: Estudo de coorte prospectivo de gestantes arroladas consecutivamente entre a 16a e 36a semanas e seguidas até o parto. Cenário: Serviços de pré-natal na rede básica de saúde em duas cidades do Rio Grande do Sul, Brasil. Método: Na linha de base, foram realizadas entrevistas padronizadas incluindo questionários de freqüência alimentar, de características sócio-demográficas e de dados clínicos das gestantes. O seguimento ocorreu até o pós-parto imediato, sendo coletado o peso da gestante registrado em cada consulta de pré-natal. O ganho de peso foi classificado em “adequado”, “insuficiente” e “excessivo” conforme recomendação do Institute of Medicine (1990). Regressão logística polinomial foi utilizada para estimar a associação entre categorias de ganho de peso e estado nutricional pré-gestacional e fatores sóciodemográficos e gestacionais. Resultados: As incidências de ganho de peso insuficiente e excessivo das 667 gestantes amostradas foram de 29,1% e 42,7%, respectivamente. As gestantes com sobrepeso e obesidade pré-gestacional apresentaram maior ganho ponderal excessivo (OR: 3,43 IC 95%: 1,72 – 6,84 & OR: 10,78 IC 95%: 4,15 – 27,97) em relação às que iniciaram eutróficas e que ganharam peso dentro das recomendações. Dentre aquelas que iniciaram a gravidez com obesidade, apenas 5,2% obtiveram ganho adequado de peso. Das gestantes que iniciaram a gravidez com baixo peso, 40,2% tiveram ganho ponderal insuficiente. Conclusões: A incidência de ganho ponderal excessivo é elevada. Embora o ganho insuficiente de peso persista como um problema de saúde pública, o ganho excessivo está se configurando como um problema que precisa de atenção imediata nos serviços de prénatal. / Background: Pregnancy weight gain is an index of maternal and fetal health, being associated to number of weeks at delivery, mode of delivery, newborn weight at delivery, and maternal weight retention after-birth. Pre-pregnancy nutritional status, food intake, and social factors are its determinants. Objective: Describe pregnant women weight gain in primary care services and its association to pre-pregnancy nutritional status and other pregnancy related factors. Design: Longitudinal cohort of pregnant women enrolled at 16-36 weeks of gestation and followed up until delivery. Setting: Prenatal care in primary attention services in two cities in Rio Grande do Sul, Brazil. Method: At baseline, socio-demographic and food frequency questionnaires were applied. Clinical features were also evaluated. Maternal weight was collected at each prenatal care visit, and follow up was held until early puerperium. According to Institute of Medicine (1990), weight gain was classified as “adequate”, “insufficient” or “excessive”. Polinomial logistic regression was used to measure association among weight gain categories and prepregnancy nutritional status and socio-demographic and pregnancy features. Results: 667 women compose sample, and insufficient and excessive weight gain incidences were 29.1%, and 42.7%, respectively. Women classified as overweight and obese before pregnancy had a significant excessive weight gain in pregnancy (OR: 3.43 CI 95%: 1.72 – 6.84 & OR: 10.78 CI 95%: 4.15 – 27.97) comparing to normal-weighted women that gained adequate weight during pregnancy. Only 5.2% of women who began pregnancy as obese had a normal weight gain. Among those classified as underweight at pregnancy beginning, 40.2% gained less weight than recommended during pregnancy. Conclusions: Excessive weight gain incidence is high. Although insufficient weight gain is still a public health problem, excessive gain is becoming a problem that needs immediate attention in prenatal care.

No description available.

No / The aim of this study was to investigate the relationship between the intake of sugar-sweetened (SS) and artificially sweetened (AS) cola beverages during pregnancy and the risk of preterm delivery (PTD). At baseline (2007–2010), 8914 pregnant women were recruited to the Born in Bradford birth cohort study at 24–28 weeks of pregnancy. Women completed a questionnaire describing their health and lifestyle behaviours, including their consumption of AS and SS cola beverages reported as cups per day, which were then linked to maternity records. The relationship between SS and AS cola beverage consumption was examined using logistic regression analyses. No relationship was observed between daily AS cola beverage consumption and PTD. Women who drank four cups per day of SS cola beverages had higher odds of a PTD when compared with women who did not consume these beverages daily. We conclude that high daily consumption of SS cola beverages during pregnancy is associated with increases in the rate of PTD.

Objetivos: Estimar a prevalência de comportamentos alimentares inadequados e fatores associados em gestantes de serviços públicos de duas cidades do sul do Brasil. Método: Estudo transversal em 515 gestantes atendidas em Porto Alegre e Bento Gonçalves, Brasil. Foram definidos comportamentos alimentares inadequados como um escore global ≥4 no instrumento Eating Disorder Examination Questionnaire (EDE-Q), e comorbidades psiquiátricas utilizando o instrumento primary care evaluation of mental disorders (PRIME-MD). Peso e altura foram medidos, peso pré-gestacional relatado. Resultados: Transtornos alimentares ocorreram em 4 gestantes 0,8% (IC95% 0,2%- 1,5%). A prevalência de compulsão alimentar foi de 18,6% (IC95% 1,7-1,8), sendo duas vezes maior naquelas gestantes com ansiedade e depressão. A compulsão alimentar durante a gestação foi quase quatro vezes maior (RP=3,7; IC 95% 2,6-5,3) entre aquelas que relataram compulsão alimentar anterior a gestação. Preocupação prévia com o peso esteve associada com uma maior prevalência de compulsão alimentar (RP=1,8; IC95% 1,2-2,9) e preocupação com o peso durante a gestação (RP=7,0; IC95% 3,7-13,5). Conclusões: A compulsão alimentar foi o comportamento alimentar inadequado mais prevalente e esteve associado com preocupação com o peso antes e durante a gestação, compulsão alimentar antes da gravidez e depressão e ansiedade durante a gravidez. / Objective: To examine the prevalence of inappropriate eating behaviors and associated factors in pregnant women who received prenatal care in a public health setting. Methods: Inappropriate eating behaviors, psychiatric comorbidity, including anxiety and depression, and BMI were assessed in 515 pregnant women attending selected prenatal clinics. Results: EDE-Q global scores indicated a prevalence of 0.8% (IC95% 0,2%-1,5%) for eating disorders. The prevalence of binge eating for the whole sample was 18.6% (IC95% 1,7-1,8), being twice as high among participants with anxiety and depression. Binge eating frequency during gestation was almost four times higher (RP=3,7; IC 95% 2,6-5,3) among women who reported binge eating before pregnancy. Previous weight concern was associated with a higher prevalence of binge eating (RP=1,8; IC95% 1,2-2,9) and weight concern (RP=7,0; IC95% 3,7-13,5) during pregnancy. Conclusion: Binge eating was the most prevalent inappropriate eating behavior, being associated with weight concern and bingeing before pregnancy, and anxiety and depression during pregnancy.

Made available in DSpace on 2015-07-22T20:50:46Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-04-29 / Introdução: Estudo previamente realizado em nosso laboratório demonstrou que a restrição alimentar intra-uterina (RAIU) provoca um retardo na termorregulação dos recém-nascidos. Em neonatos o tecido adiposo marrom (TAM) é essencial para a termogênese, principalmente devido à presença de proteínas desacopladoras (UCPs), cuja expressão pode ser modificada pela ação de hormônios como os hormônios da tireóide, a leptina e a insulina, que podem ser afetados pela restrição alimentar. A bomba de cálcio do retículo sarcoplasmático (SERCA1), presente no músculo e recentemente identificada no TAM, pode contribuir para a produção de calor. Objetivo: Avaliar a expressão das proteínas UCP1, UCP2, UCP3 e da SERCA1 no TAM e da UCP3 e da SERCA1 no músculo esquelético (ME) de animais submetidos a RAIU, bem como o perfil plasmático de insulina, leptina e hormônios tireoidianos destes filhotes. Métodos: Ratos fêmeas Wistar EPM-1 controle (C) receberam ração ad libitum durante todo o período gestacional e o grupo restrito (R) recebeu 50% desta quantidade. Quinze horas após o nascimento (pico de expressão das UCPs), os filhotes foram pesados e decapitados para coleta de sangue (pool) para a dosagem plasmática de insulina, leptina, T3 e T4 por ELISA. Foram coletados TAM e ME, para determinação da expressão das UCPs e da SERCA1 por imuno-histoquímica. Para análise dos resultados, utilizou-se o teste “t” de Student não pareado, com nível de significância de 5%. Resultados: Os animais R (n=16) apresentaram durante a gestação um ganho de peso corporal (g) significantemente inferior quando comparado ao C (n=16), (27,6 ± 3,8 e 109,0 ± 4,1). Os filhotes R (n=172) apresentaram redução significante do peso corporal (g) ao nascimento em relação aos filhotes C (n=169) (4,82 ± 0,05 e 5,83 ± 0,04); entretanto, não houve redução no número de filhotes por ninhada. A RAIU levou a um aumento significante na expressão (pixels) da UCP1 e da UCP2 no TAM da prole R em relação à prole C (em 42% e 53%, respectivamente). Não observamos diferença significante entre os grupos em relação à expressão da UCP3 e da SERCA1 no TAM e no ME. A concentração plasmática de insulina (ng/ml) foi significantemente maior nos filhotes R (n=8) em relação aos C (n=13) (3,34 ± 0,78 e 1,17 ± 0,18) e os níveis plasmáticos de T3 (ng/ml) foram significantemente menores nos filhotes R (n=10) quando comparados aos C (n=14) (0,82 ± 0,06 e 1,09 ± 0,08). Não houve diferenças significantes para as dosagens plasmáticas de leptina (pg/ml) (R (n=8) 987,79 ± 261,08 e C (n=11) 1255,54 ± 392,37) e T4 (ng/ml) (R (n=10) 20,99 ± 3,74 e C (n=12) 16,00 ± 1,68). Conclusão: O atraso no desenvolvimento da termorregulação previamente descritos nesses animais não parece resultar de redução na termogênese, mas de aumento na termólise, pois a RAIU provocou baixo peso dos filhotes ao nascimento, levando a uma maior relação superfície/ volume. A maior expressão da UCP1 e UCP2 no TAM observada nos filhotes restritos possivelmente ocorreu como um mecanismo compensatório para aumentar a termogênese, o que pode ter sido modulado por ação hormonal. / Background: Previous study from our laboratory has shown that intrauterine food restriction (IUFR) delayed thermoregulation of the newborns. In neonates brown adipose tissue (BAT) is essential for thermogenesis mainly due to the presence of uncoupling proteins (UCPs) and their expression can be modified by action of hormones such as thyroid hormone, leptin and insulin, which can be affected by food restriction. The sarcoplasmic reticulum Ca++ ATPase, (SERCA1) recently identified in BAT may contribute to heat production. Aim: The aim of this study was to evaluate the protein expression of UCP1, UCP2, UCP3 and SERCA1 in BAT and UCP3 and SERCA1 in skeletal muscle (SM) and the plasmatic concentration of insulin, leptin, T3 and T4 of newborn rats exposed to IUFR. Methods: Female Wistar EPM-1 control rats received chow ad libitum during pregnancy period (C) and food-restricted rats (R) received 50% of the amount ingested by C. Fifteen hours after birth, newborns were weighted and sacrificed by decapitation. Blood was collected for determination of insulin, leptin, T3 and T4 by ELISA. BAT and SM were used for determination of protein expression (UCPs and SERCA1) by immunohistochemistry. Unpaired Student’s t-test was used for statistical analysis of the results (p<0,05). Results: R animals (n=16) showed a significant lower weight gain (g) during pregnancy when compared to C (n=16) (27,6 ± 3,8 and 109,0 ± 4,1). R pups (n=172) showed a significant reduction in their body weight (g) at birth when compared to C (n=169) (4,82 ± 0,05 and 5,83 ± 0,04); however, there was no reduction in number of pups per litter. IUFR caused a significant increase in the expression (pixels) of UCP1 and UCP2 in BAT of the pups (42% and 53% respectively). UCP3 and SERCA1 expression in BAT and SM showed no significant differences between groups. Plasmatic insulin (ng/ml) was significantly higher in R pups (n=8) when compared to C (n=13) (3,34 ± 0,78 and 1,17 ± 0,18) and T3 levels (ng/ml) was significantly lower in R pups (n=10) when compared to C (n=14) (0,82 ± 0,06 and 1,09 ± 0,08). No differences between groups were found for leptin (pg/ml) (R (n=8) 987,79 ± 261,08 and C (n=11) 1255,54 ± 392,37) and T4 (ng/ml) levels (R (n=10) 20,99 ± 3,74 and C (n=12) 16,00 ± 1,68). Conclusion: The delay in development of thermoregulation previously described in these animals appears not to result from impairment in thermogenesis, but from an increase in heat loss, since IUFR caused low birth weight in pups, leading to greater surface/ volume ratio. The higher expression of UCP1 and UCP2 in BAT showed by R pups possibly occurred as a compensatory mechanism to increase thermogenesis, which may have been modulated by hormonal regulation. / TEDE / BV UNIFESP: Teses e dissertações

Objetivos: Estimar a prevalência de comportamentos alimentares inadequados e fatores associados em gestantes de serviços públicos de duas cidades do sul do Brasil. Método: Estudo transversal em 515 gestantes atendidas em Porto Alegre e Bento Gonçalves, Brasil. Foram definidos comportamentos alimentares inadequados como um escore global ≥4 no instrumento Eating Disorder Examination Questionnaire (EDE-Q), e comorbidades psiquiátricas utilizando o instrumento primary care evaluation of mental disorders (PRIME-MD). Peso e altura foram medidos, peso pré-gestacional relatado. Resultados: Transtornos alimentares ocorreram em 4 gestantes 0,8% (IC95% 0,2%- 1,5%). A prevalência de compulsão alimentar foi de 18,6% (IC95% 1,7-1,8), sendo duas vezes maior naquelas gestantes com ansiedade e depressão. A compulsão alimentar durante a gestação foi quase quatro vezes maior (RP=3,7; IC 95% 2,6-5,3) entre aquelas que relataram compulsão alimentar anterior a gestação. Preocupação prévia com o peso esteve associada com uma maior prevalência de compulsão alimentar (RP=1,8; IC95% 1,2-2,9) e preocupação com o peso durante a gestação (RP=7,0; IC95% 3,7-13,5). Conclusões: A compulsão alimentar foi o comportamento alimentar inadequado mais prevalente e esteve associado com preocupação com o peso antes e durante a gestação, compulsão alimentar antes da gravidez e depressão e ansiedade durante a gravidez. / Objective: To examine the prevalence of inappropriate eating behaviors and associated factors in pregnant women who received prenatal care in a public health setting. Methods: Inappropriate eating behaviors, psychiatric comorbidity, including anxiety and depression, and BMI were assessed in 515 pregnant women attending selected prenatal clinics. Results: EDE-Q global scores indicated a prevalence of 0.8% (IC95% 0,2%-1,5%) for eating disorders. The prevalence of binge eating for the whole sample was 18.6% (IC95% 1,7-1,8), being twice as high among participants with anxiety and depression. Binge eating frequency during gestation was almost four times higher (RP=3,7; IC 95% 2,6-5,3) among women who reported binge eating before pregnancy. Previous weight concern was associated with a higher prevalence of binge eating (RP=1,8; IC95% 1,2-2,9) and weight concern (RP=7,0; IC95% 3,7-13,5) during pregnancy. Conclusion: Binge eating was the most prevalent inappropriate eating behavior, being associated with weight concern and bingeing before pregnancy, and anxiety and depression during pregnancy.

Objetivos: Estimar a prevalência de comportamentos alimentares inadequados e fatores associados em gestantes de serviços públicos de duas cidades do sul do Brasil. Método: Estudo transversal em 515 gestantes atendidas em Porto Alegre e Bento Gonçalves, Brasil. Foram definidos comportamentos alimentares inadequados como um escore global ≥4 no instrumento Eating Disorder Examination Questionnaire (EDE-Q), e comorbidades psiquiátricas utilizando o instrumento primary care evaluation of mental disorders (PRIME-MD). Peso e altura foram medidos, peso pré-gestacional relatado. Resultados: Transtornos alimentares ocorreram em 4 gestantes 0,8% (IC95% 0,2%- 1,5%). A prevalência de compulsão alimentar foi de 18,6% (IC95% 1,7-1,8), sendo duas vezes maior naquelas gestantes com ansiedade e depressão. A compulsão alimentar durante a gestação foi quase quatro vezes maior (RP=3,7; IC 95% 2,6-5,3) entre aquelas que relataram compulsão alimentar anterior a gestação. Preocupação prévia com o peso esteve associada com uma maior prevalência de compulsão alimentar (RP=1,8; IC95% 1,2-2,9) e preocupação com o peso durante a gestação (RP=7,0; IC95% 3,7-13,5). Conclusões: A compulsão alimentar foi o comportamento alimentar inadequado mais prevalente e esteve associado com preocupação com o peso antes e durante a gestação, compulsão alimentar antes da gravidez e depressão e ansiedade durante a gravidez. / Objective: To examine the prevalence of inappropriate eating behaviors and associated factors in pregnant women who received prenatal care in a public health setting. Methods: Inappropriate eating behaviors, psychiatric comorbidity, including anxiety and depression, and BMI were assessed in 515 pregnant women attending selected prenatal clinics. Results: EDE-Q global scores indicated a prevalence of 0.8% (IC95% 0,2%-1,5%) for eating disorders. The prevalence of binge eating for the whole sample was 18.6% (IC95% 1,7-1,8), being twice as high among participants with anxiety and depression. Binge eating frequency during gestation was almost four times higher (RP=3,7; IC 95% 2,6-5,3) among women who reported binge eating before pregnancy. Previous weight concern was associated with a higher prevalence of binge eating (RP=1,8; IC95% 1,2-2,9) and weight concern (RP=7,0; IC95% 3,7-13,5) during pregnancy. Conclusion: Binge eating was the most prevalent inappropriate eating behavior, being associated with weight concern and bingeing before pregnancy, and anxiety and depression during pregnancy.

La prééclampsie est responsable du quart des mortalités maternelles et est la deuxième cause de décès maternels associés à la grossesse au Canada et dans le monde. L’identification d’une stratégie efficace pour la prévention de la prééclampsie est une priorité et un défi primordial dans les milieux de recherche en obstétrique. Le rôle des éléments nutritifs dans le développement de la prééclampsie a récemment reçu davantage d’attention. Plusieurs études cliniques et épidémiologiques ont été menées pour déterminer les facteurs de risque alimentaires potentiels et examiner les effets d’une supplémentation nutritive dans le développement de troubles hypertensifs de la grossesse. Pour déterminer les effets de suppléments antioxydants pris pendant la grossesse sur le risque d’hypertension gestationnelle (HG) et de prééclampsie, un essai multicentrique contrôlé à double insu a été mené au Canada et au Mexique (An International Trial of Antioxidants in the Prevention of Preeclampsia – INTAPP). Les femmes, stratifiées par risque, étaient assignées au traitement expérimental quotidien (1 gramme de vitamine C et 400 UI de vitamine E) ou au placebo. En raison des effets secondaires potentiels, le recrutement pour l’essai a été arrêté avant que l’échantillon complet ait été constitué. Au total, 2640 femmes éligibles ont accepté d’être recrutées, dont 2363 (89.5%) furent incluses dans les analyses finales. Nous n’avons retrouvé aucune évidence qu’une supplémentation prénatale de vitamines C et E réduisait le risque d’HG et de ses effets secondaires (RR 0,99; IC 95% 0,78-1,26), HG (RR 1,04; IC 95% 0,89-1,22) et prééclampsie (RR 1,04; IC 95% 0,75-1,44). Toutefois, une analyse secondaire a révélé que les vitamines C et E augmentaient le risque de « perte fœtale ou de décès périnatal » (une mesure non spécifiée au préalable) ainsi qu’une rupture prématurée des membranes avant terme. Nous avons mené une étude de cohorte prospective chez les femmes enceintes recrutées dans l’INTAPP afin d’évaluer les relations entre le régime alimentaire maternel en début et fin de grossesse et le risque de prééclampsie et d’HG. Un questionnaire de fréquence alimentaire validé était administré deux fois pendant la grossesse (12-18 semaines, 32-34 semaines). Les analyses furent faites séparément pour les 1537 Canadiennes et les 799 Mexicaines en raison de l’hétérogénéité des régimes alimentaires des deux pays. Parmi les canadiennes, après ajustement pour l’indice de masse corporelle (IMC) précédant la grossesse, le groupe de traitement, le niveau de risque (élevé versus faible) et les autres facteurs de base, nous avons constaté une association significative entre un faible apport alimentaire (quartile inférieur) de potassium (OR 1,79; IC 95% 1,03-3,11) et de zinc (OR 1,90; IC 95% 1,07-3,39) et un risque augmenté de prééclampsie. Toujours chez les Canadiennes, le quartile inférieur de consommation d’acides gras polyinsaturés était associé à un risque augmenté d’HG (OR 1,49; IC 95% 1,09-2,02). Aucun des nutriments analysés n’affectait les risques d’HG ou de prééclampsie chez les Mexicaines. Nous avons entrepris une étude cas-témoins à l’intérieur de la cohorte de l’INTAPP pour établir le lien entre la concentration sérique de vitamines antioxydantes et le risque de prééclampsie. Un total de 115 cas de prééclampsie et 229 témoins ont été inclus. Les concentrations de vitamine E ont été mesurées de façon longitudinale à 12-18 semaines (avant la prise de suppléments), à 24-26 semaines et à 32-34 semaines de grossesse en utilisant la chromatographie liquide de haute performance. Lorsqu’examinée en tant que variable continue et après ajustement multivarié, une concentration de base élevée de gamma-tocophérol était associée à un risque augmenté de prééclampsie (quartile supérieur vs quartile inférieur à 24-26 semaines : OR 2,99, IC 95% 1,13-7,89; à 32-34 semaines : OR 4,37, IC 95% 1,35-14,15). Nous n’avons pas trouvé de lien entre les concentrations de alpha-tocophérol et le risque de prééclampsie. En résumé, nous n’avons pas trouvé d’effets de la supplémentation en vitamines C et E sur le risque de prééclampsie dans l’INTAPP. Nous avons toutefois trouvé, dans la cohorte canadienne, qu’une faible prise de potassium et de zinc, tel qu’estimée par les questionnaires de fréquence alimentaire, était associée à un risque augmenté de prééclampsie. Aussi, une plus grande concentration sérique de gamma-tocophérol pendant la grossesse était associée à un risque augmenté de prééclampsie. / Preeclampsia (PE) accounts for about one-quarter of cases of maternal mortality, and ranks second among the causes of pregnancy-associated maternal deaths in Canada and worldwide. The identification of an effective strategy to prevent PE is a priority and fundamental challenge in obstetrics research. The role of nutritional factors in the etiology of PE has recently received increased attention. Many clinical and epidemiological studies have been conducted to investigate potential dietary risk factors for PE and to examine the effects of nutritional supplementation on the development of hypertensive disorders of pregnancy. To investigate the effects of prenatal antioxidant supplementation on the risk of gestational hypertension (GH) and PE, a double blind, multicenter trial (The International Trial of Antioxidants for the Prevention of Preeclampsia – the INTAPP trial) was conducted in Canada and in Mexico. Women were stratified by their risk status and assigned to daily experimental treatment (1 gram vitamin C and 400 IU vitamin E) or to placebo. Due to concerns about potential adverse effects, recruitment for the trial was stopped before the full sample had been achieved. A total of 2640 consenting eligible women had been recruited at that point with 2363 women (89.5%) included in the final analysis. We found no evidence that prenatal supplementation of vitamins C and E reduced the risk of GH and its adverse conditions (RR: 0.99, 95% CI 0.78-1.26), GH (RR 1.04, 95% CI 0.89-1.22), and PE (RR 1.04, 95% CI 0.75-1.44). However, in a secondary analysis, we found that vitamins C and E increased the risk of ‘fetal loss or perinatal death’ (a non-pre-specified outcome) as well as preterm premature rupture of membranes (PPROM). We conducted a prospective cohort study on pregnant women enrolled in the INTAPP trial to investigate the associations between maternal diet in early and late pregnancy and the risk of PE and GH. A validated food frequency questionnaire (FFQ) was administered twice during pregnancy (12-18 weeks, 32-34 weeks). Analyses were conducted separately for 1537 Canadian and 799 Mexican women as there were significant heterogeneities in various nutrient intakes between the two countries. Among Canadian women, after adjusting for pre-pregnancy body mass index (BMI), treatment group, risk stratum (high versus low) and other baseline risk factors, we found that the lowest quartiles of potassium (OR 1.79, 95% CI 1.03-3.11) and zinc (OR 1.90, 95% CI 1.07-3.39) intake were significantly associated with an increased risk of PE. Also in Canadian women, the lowest quartile of polyunsaturated fatty acids was associated with an increased risk of GH (OR 1.49, 95% CI 1.09-2.02). None of the nutrients analyzed were found to be associated with PE and GH risk among Mexican women. We further conducted a case control study ancillary to the INTAPP trial to assess the relationship between plasma concentration of antioxidant vitamins and the risk of PE. A total of 115 PE cases and 229 matched controls were included. Vitamin E concentrations were measured longitudinally at 12-18 weeks (prior to supplementation), 24-26 weeks, and 32-34 weeks of gestation using high-performance liquid chromatography (HPLC). When examined as a continuous variable, and after multivariate adjustment, elevated baseline gamma-tocopherol concentrations were associated with an increased risk of PE (OR 1.35, 95% CI 1.02-1.78). Analyses of repeated measurements indicated that elevated gamma-tocopherol levels were associated with an increased risk of PE (highest vs. lowest quartile at 24-26 weeks: OR 2.99, 95% CI 1.13-7.89; at 32-34 weeks: OR 4.37, 95% CI 1.35-14.15). We found no associations between alpha-tocopherol concentrations and the risk of PE. In summary, we found no effects of vitamins C and E supplementation on the risk of PE in the INTAPP trial. However, in the Canadian cohort we found that lower intakes of potassium and zinc as estimated by the FFQ were associated with an increased risk of PE. Moreover, higher plasma concentration of gamma-tocopherol during pregnancy was associated with an increased risk of PE.

La prééclampsie est responsable du quart des mortalités maternelles et est la deuxième cause de décès maternels associés à la grossesse au Canada et dans le monde. L’identification d’une stratégie efficace pour la prévention de la prééclampsie est une priorité et un défi primordial dans les milieux de recherche en obstétrique. Le rôle des éléments nutritifs dans le développement de la prééclampsie a récemment reçu davantage d’attention. Plusieurs études cliniques et épidémiologiques ont été menées pour déterminer les facteurs de risque alimentaires potentiels et examiner les effets d’une supplémentation nutritive dans le développement de troubles hypertensifs de la grossesse. Pour déterminer les effets de suppléments antioxydants pris pendant la grossesse sur le risque d’hypertension gestationnelle (HG) et de prééclampsie, un essai multicentrique contrôlé à double insu a été mené au Canada et au Mexique (An International Trial of Antioxidants in the Prevention of Preeclampsia – INTAPP). Les femmes, stratifiées par risque, étaient assignées au traitement expérimental quotidien (1 gramme de vitamine C et 400 UI de vitamine E) ou au placebo. En raison des effets secondaires potentiels, le recrutement pour l’essai a été arrêté avant que l’échantillon complet ait été constitué. Au total, 2640 femmes éligibles ont accepté d’être recrutées, dont 2363 (89.5%) furent incluses dans les analyses finales. Nous n’avons retrouvé aucune évidence qu’une supplémentation prénatale de vitamines C et E réduisait le risque d’HG et de ses effets secondaires (RR 0,99; IC 95% 0,78-1,26), HG (RR 1,04; IC 95% 0,89-1,22) et prééclampsie (RR 1,04; IC 95% 0,75-1,44). Toutefois, une analyse secondaire a révélé que les vitamines C et E augmentaient le risque de « perte fœtale ou de décès périnatal » (une mesure non spécifiée au préalable) ainsi qu’une rupture prématurée des membranes avant terme. Nous avons mené une étude de cohorte prospective chez les femmes enceintes recrutées dans l’INTAPP afin d’évaluer les relations entre le régime alimentaire maternel en début et fin de grossesse et le risque de prééclampsie et d’HG. Un questionnaire de fréquence alimentaire validé était administré deux fois pendant la grossesse (12-18 semaines, 32-34 semaines). Les analyses furent faites séparément pour les 1537 Canadiennes et les 799 Mexicaines en raison de l’hétérogénéité des régimes alimentaires des deux pays. Parmi les canadiennes, après ajustement pour l’indice de masse corporelle (IMC) précédant la grossesse, le groupe de traitement, le niveau de risque (élevé versus faible) et les autres facteurs de base, nous avons constaté une association significative entre un faible apport alimentaire (quartile inférieur) de potassium (OR 1,79; IC 95% 1,03-3,11) et de zinc (OR 1,90; IC 95% 1,07-3,39) et un risque augmenté de prééclampsie. Toujours chez les Canadiennes, le quartile inférieur de consommation d’acides gras polyinsaturés était associé à un risque augmenté d’HG (OR 1,49; IC 95% 1,09-2,02). Aucun des nutriments analysés n’affectait les risques d’HG ou de prééclampsie chez les Mexicaines. Nous avons entrepris une étude cas-témoins à l’intérieur de la cohorte de l’INTAPP pour établir le lien entre la concentration sérique de vitamines antioxydantes et le risque de prééclampsie. Un total de 115 cas de prééclampsie et 229 témoins ont été inclus. Les concentrations de vitamine E ont été mesurées de façon longitudinale à 12-18 semaines (avant la prise de suppléments), à 24-26 semaines et à 32-34 semaines de grossesse en utilisant la chromatographie liquide de haute performance. Lorsqu’examinée en tant que variable continue et après ajustement multivarié, une concentration de base élevée de gamma-tocophérol était associée à un risque augmenté de prééclampsie (quartile supérieur vs quartile inférieur à 24-26 semaines : OR 2,99, IC 95% 1,13-7,89; à 32-34 semaines : OR 4,37, IC 95% 1,35-14,15). Nous n’avons pas trouvé de lien entre les concentrations de alpha-tocophérol et le risque de prééclampsie. En résumé, nous n’avons pas trouvé d’effets de la supplémentation en vitamines C et E sur le risque de prééclampsie dans l’INTAPP. Nous avons toutefois trouvé, dans la cohorte canadienne, qu’une faible prise de potassium et de zinc, tel qu’estimée par les questionnaires de fréquence alimentaire, était associée à un risque augmenté de prééclampsie. Aussi, une plus grande concentration sérique de gamma-tocophérol pendant la grossesse était associée à un risque augmenté de prééclampsie. / Preeclampsia (PE) accounts for about one-quarter of cases of maternal mortality, and ranks second among the causes of pregnancy-associated maternal deaths in Canada and worldwide. The identification of an effective strategy to prevent PE is a priority and fundamental challenge in obstetrics research. The role of nutritional factors in the etiology of PE has recently received increased attention. Many clinical and epidemiological studies have been conducted to investigate potential dietary risk factors for PE and to examine the effects of nutritional supplementation on the development of hypertensive disorders of pregnancy. To investigate the effects of prenatal antioxidant supplementation on the risk of gestational hypertension (GH) and PE, a double blind, multicenter trial (The International Trial of Antioxidants for the Prevention of Preeclampsia – the INTAPP trial) was conducted in Canada and in Mexico. Women were stratified by their risk status and assigned to daily experimental treatment (1 gram vitamin C and 400 IU vitamin E) or to placebo. Due to concerns about potential adverse effects, recruitment for the trial was stopped before the full sample had been achieved. A total of 2640 consenting eligible women had been recruited at that point with 2363 women (89.5%) included in the final analysis. We found no evidence that prenatal supplementation of vitamins C and E reduced the risk of GH and its adverse conditions (RR: 0.99, 95% CI 0.78-1.26), GH (RR 1.04, 95% CI 0.89-1.22), and PE (RR 1.04, 95% CI 0.75-1.44). However, in a secondary analysis, we found that vitamins C and E increased the risk of ‘fetal loss or perinatal death’ (a non-pre-specified outcome) as well as preterm premature rupture of membranes (PPROM). We conducted a prospective cohort study on pregnant women enrolled in the INTAPP trial to investigate the associations between maternal diet in early and late pregnancy and the risk of PE and GH. A validated food frequency questionnaire (FFQ) was administered twice during pregnancy (12-18 weeks, 32-34 weeks). Analyses were conducted separately for 1537 Canadian and 799 Mexican women as there were significant heterogeneities in various nutrient intakes between the two countries. Among Canadian women, after adjusting for pre-pregnancy body mass index (BMI), treatment group, risk stratum (high versus low) and other baseline risk factors, we found that the lowest quartiles of potassium (OR 1.79, 95% CI 1.03-3.11) and zinc (OR 1.90, 95% CI 1.07-3.39) intake were significantly associated with an increased risk of PE. Also in Canadian women, the lowest quartile of polyunsaturated fatty acids was associated with an increased risk of GH (OR 1.49, 95% CI 1.09-2.02). None of the nutrients analyzed were found to be associated with PE and GH risk among Mexican women. We further conducted a case control study ancillary to the INTAPP trial to assess the relationship between plasma concentration of antioxidant vitamins and the risk of PE. A total of 115 PE cases and 229 matched controls were included. Vitamin E concentrations were measured longitudinally at 12-18 weeks (prior to supplementation), 24-26 weeks, and 32-34 weeks of gestation using high-performance liquid chromatography (HPLC). When examined as a continuous variable, and after multivariate adjustment, elevated baseline gamma-tocopherol concentrations were associated with an increased risk of PE (OR 1.35, 95% CI 1.02-1.78). Analyses of repeated measurements indicated that elevated gamma-tocopherol levels were associated with an increased risk of PE (highest vs. lowest quartile at 24-26 weeks: OR 2.99, 95% CI 1.13-7.89; at 32-34 weeks: OR 4.37, 95% CI 1.35-14.15). We found no associations between alpha-tocopherol concentrations and the risk of PE. In summary, we found no effects of vitamins C and E supplementation on the risk of PE in the INTAPP trial. However, in the Canadian cohort we found that lower intakes of potassium and zinc as estimated by the FFQ were associated with an increased risk of PE. Moreover, higher plasma concentration of gamma-tocopherol during pregnancy was associated with an increased risk of PE.