CenteringPregnancy is a model of group prenatal care that replaces routine, individual prenatal care. The program brings women together into small groups to receive their care and prenatal education, and is based on three components: risk assessment, education, and support. The model is client-centered, designed to empower pregnant women and support persons, and involves the woman in small group discussions of 8-10 other women of similar gestational age. The group discussions provide support, help women educate each other, and invoke self-monitoring. Currently, there have been few publications that closely examined maternal weight and obesity and associated outcomes in women involved in CenteringPregnancy; and there are a limited number of studies that examined Spanish-speaking CP groups with Latinas. Therefore, the primary purpose of this retrospective cohort study was to compare pregnancy outcomes of Latina women who completed CenteringPregnancy in a public health clinic to women who completed individual care in the same clinic during the same time. The secondary purpose of this study was to understand perceptions of care among multiparous women who recently completed CenteringPregnancy and completed individual prenatal care in the past. Both quantitative and qualitative methods were employed to examine differences in pregnancy outcomes and maternal factors in both prenatal care groups, and to understand women's perceptions and experience in both CenteringPregnancy and individual prenatal care. A total of 487 patient charts were obtained for data collection (Intervention n= 247, Comparison n=240) and 10 women who recently completed CenteringPregnancy at the health department and completed individual prenatal care in the past completed in person in-depth interviews. The results indicated that there were no differences in infant birthweight or gestational age at delivery between the groups. Compared to women in individual care, women in CenteringPregnancy had increased odds of: having a vaginal birth as opposed to a primary cesarean section, aOR =2.57, (95% CI: 1.23-5.36), attending prenatal care visits, aOR=11.03, (95% CI: 4.53, 26.83), attending postpartum care visits, aOR=2.21 (95% CI: 1.20, 4.05) and formula-only feeding their infants, aOR=6.07 (95% CI: 2.57-14.31). Compared to women in individual care, women in CenteringPregnancy had decreased odds of gaining below the recommended amount of gestational weight, aOR=0.41, (95% CI: 0.22, 0.78). Qualitative findings indicated that women who complete CenteringPregnancy were more satisfied with their care, received more education and support and were more empowered to make decisions about their pregnancy and childbirth. The program provides a system of social support that encapsulates all types of social support to provide relief of stress, encourage positive relationships and empower women to help facilitate healthy pregnancies. CenteringPregnancy at the Pinellas County Health Department increased health care utilization and informed and empowered women through social support.

Contexte : La corpulence de la femme est fortement associée à la croissance foetale. C’est pourquoi l’augmentation du poids des femmes en France devrait s’accompagner d’une augmentation parallèle du poids de naissance. Des modèles animaux ont récemment suggéré qu’en dehors de l’IMC avant grossesse, les variations du poids maternel dans la période périconceptionnelle peuvent être des indicateurs de son statut nutritionnel pendant cette période et influencer la croissance foetale et le déroulement de la grossesse.Objectif : 1) Evaluer les évolutions de la corpulence des femmes et du poids de naissance. 2) Analyser le rôle de la nutrition périconceptionnelle maternelle sur la croissance foetale et le déroulement de la grossesse.Populations : Les données utilisées pour cette thèse sont celles des enquêtes ObEpi, des enquêtes nationales périnatales françaises et de l’étude EDEN. 1) Pour chaque année d’enquête ObEpi (1997, 2000, 2003, 2006), des données sur le poids et la taille ont été obtenues par des questionnaires envoyés à 20000 ménages représentatifs de la population nationale. 2) Les paires mère-enfant parmi les naissances uniques vivantes des enquêtes périnatales de 1972, 1981, 1995, 1998 et 2003 ont été sélectionnées (n=8664, 4494, 11445, 12006, 12692, respectivement). Lors des enquêtes périnatales, les mères ont répondu à des questionnaires quelques jours après l’accouchement et des données sur le nouveau-né et l’accouchement ont été obtenues à partir du dossier médical. 3) Dans l’étude EDEN qui a inclu 2002 femmes recrutées dans les centres de Nancy et de Poitiers, les poids des femmes à l’âge de 20 ans et juste avant la grossesse, l’anthropométrie du foetus aux 2nd et 3`eme trimestres, le poids de naissance et les complications de la grossesse ont été recueillis. Des mesures de poids des femmes au cours de la grossesse ont été disponibles et ont permis d’estimer le poids des femmes à chaque semaine de la grossesse avec un modèle mixte.Résultats : L’analyse d’un effet cohorte de naissance avec les données des enquêtes ObEpi a montré une accélération de l’augmentation de la prévalence de l’obésité pour les générations nées après les années 1960 en particulier chez les femmes. L’augmentation de l’IMC avant grossesse en France s’est accompagnée d’une augmentation du poids de naissance de 1972 à 1995, avec une tendance à la baisse du poids de naissance par la suite. Par ailleurs, nous avons mis en évidence qu’une perte de poids depuis l’âge de 20 ans chez les femmes qui avaient un IMC <25kg/m2 était associée à un risque augmenté d’avoir un bébé petit pour son âge gestationnel après ajustement sur l’IMC avant grossesse. Une prise de poids avant la grossesse était associée à des risques augmentés de diabète et d’hypertension gestationnels après ajustement sur l’IMC avant grossesse. La variation du poids de la femme au premier trimestre de la grossesse était spécifiquement associée à la croissance fœtale et à la corpulence du nouveau-né indépendamment des variations au 2nd et au 3ème trimestres.Conclusion : Les hommes et les femmes nés après les années 1960 ont été exposés à un environnement qui a augmenté leur susceptibilité à l’obésité tout au long de la vie. Par ailleurs, des recherches supplémentaires sont nécessaires pour comprendre les facteurs associés à la non augmentation du poids de naissance depuis les années 1995 malgré une augmentation du poids des femmes. Nos résultats font penser que les variations de poids pré-conceptionnelles pourraient être prises en compte dans l’évaluation du risque obstétrical. / Birthweight is strongly and positively related to maternal preconceptional weight as well as with weight gain during pregnancy. Therefore, it would be expected that the increase in maternal weight before pregnancy, and weight gain during pregnancy, would be associated with an increase in birthweight in France. Animal models suggested that maternal weight changes in the periconceptional period can be considered as indicators of maternal energy balance and nutritional status, and may be involved in fetal growth and pregnancy outcomes.Obejective : 1) To evaluate time trends in maternal body size and birthweight. 2) To investigate the association of maternal weight changes in the periconceptional period with fetal growth and adverse pregnancy outcomes.Background : Birthweight is strongly and positively related to maternal preconceptional weight as well as with weight gain during preg Populations : Data were from ObEpi surveys ; French nationally representative perinatal surveys and the EDEN study. 1) For every ObEpi survey (1997, 2000, 2003 and 2006), data on weight and height were obtained for 20000 households representative of the French population.2) Mother-child pairs among singleton live births were included in the national perinatal surveys in 1972, 1981, 1995, 1998 and 2003 (n=8664, 4494, 11445, 12692 respectively). Mothers were interviewed a few days after delivery and data on delivery and the newborn were extracted from hospital records. 3) In the EDEN mother-child cohort, 1756 mother–child pairs had information on mother’s weight at 20 years, weight just before pregnancy, fetal anthropometry at second and third trimesters, infant’s birthweight and pregnancy complications. Also in the EDEN study 1744 women had prepregnancy weight available and at least 5 measures of weight in pregnancy. We extrapolated women’s weight at each week of gestation with a three-degrees polynomial model and estimated weight change during each trimester of gestation.Results : 1) Analyses based on data from ObEPI surveys showed that more recent cohorts (those born after the 1960’s) experienced an accelerated increase in the prevalence of obesity in relation to age during 1997-2006 particularly for women when compared with older birth cohorts. 2) Body mass index and weight gain during pregnancy increased between 1972 and 2003 ; paradoxically birth weight did not show a parallel increase. In fact, after adjusting for several potential confounders birthweight showed a decrease between 1995 and 2003.This corresponded with an increase in babies born small-for-gestational age (SGA) and a decrease in those born large-for-gestational age (LGA). 3) In women with BMI < 25 kg/m2, weight loss before pregnancy was associated with less fetal growth and increased risk of SGA.Factors including anemia and pathologies such as cancer were also considered but did not explain the findings. On the other hand, “large” weight gain between age 20 and pregnancy was associated with increased risk of gestational diabetes irrespective of overweight status of the woman. 4) Lastly, a significant association between the variation in maternal weightover the first trimester of pregnancy and fetal growth was noted even after accounting for the variation in weight over the last two trimesters. This association was independent of weight gain later in pregnancy and was partly explained by placental weight showing the importance of periconceptual nutritional status.Conclusion : Although the obesity epidemic became apparent in adults only in the 1990s in France, some of its origins can be found as early as the mid 1960s. The increasing trend in the prevalence of SGA in France, and in other countries such like the US, should prioritize research efforts towards a better understanding of the causes of this time trend. Our datasuggest that weight changes in periconceptional period could be taken into account when evaluating the obstetrical risk.

Introdução e objetivos – A finalidade prioritária no tratamento do diabetes mellitus gestacional (DMG) é alcançar níveis de glicemia materna tão próximos da normalidade quanto possível, a fim de reduzir os efeitos adversos associados à hiperglicemia na gestação. A auto verificação da glicemia capilar (perfil glicêmico) é o método mais usado para a monitorização do controle metabólico na gestação complicada por diabetes. Nosso objetivo foi analisar as associações entre os perfis glicêmicos maternos com os principais desfechos da gestação numa população de mulheres com DMG acompanhadas em ambulatório de pré-natal especializado em hospital universitário no sul do Brasil, Hospital de Clínicas de Porto Alegre (HCPA). Desenho e metodotologia – conduzimos um estudo de coorte prospectiva de gestantes referidas da rede de atenção primária de saúde pública para tratamento do DMG no HCPA, acompanhadas do diagnóstico ao parto. Pesquisamos associações entre os resultados dos perfis glicêmicos com o peso de nascimento e com o risco de recém-nascidos grandes para idade gestacional e de desfechos adversos perinatais. Resultados – acompanhamos 440 mulheres com DMG. A média do índice de massa corporal (IMC) foi 33.3kg/m2. 351 bebês (79.8%) mostraram peso adequado à idade gestacional no nascimento. As médias de glicemia nos perfis pré e pósprandiais aumentaram com o avanço na categoria de peso nascimento. Três ou mais perfis glicêmicos anormais foram o fator de risco mais robusto para o nascimento de bebês grandes (OR 3.15 1.51-6.55) e para o desenvolvimento de desfechos adversos perinatais (OR 2.28 1.59-3.29). O ganho de peso materno durante o tratamento associou-se ao risco de recém-nascido grande para idade gestacional, assim como o IMC pré-gestacional, esse último também fator de risco independente para eventos perinatais adversos. Conclusão – perfis glicêmicos anormais em mais de 2 ocasiões foram o fator de risco mais relacionado ao nascimento de um bebê grande para a idade gestacional e para o desenvolvimento de complicações neonatais. Efeito benéfico do tratamento do DMG, guiado pelos perfis glicêmicos, foi a maioria de recém-nascidos com peso adequado à idade gestacional nessa coorte, apesar da incidência de desfechos perinatais adversos não ter sido diferente entre as categorias de peso fetal de nascimento. / Background and objective – a priority target in the treatment of gestational diabetes mellitus (GDM) is attaining maternal glucose levels as close as possible to euglycemia, in order to decrease the adverse outcomes linked to hyperglycemia. Self-performed capillary glucose (glycemic profile) is the most widely used method for metabolic monitoring in pregnancy complicated by diabetes. We intended to analyze the associations of maternal glycemic profile to main pregnancy outcomes in a population of GDM women treated in a specialized prenatal clinic at a university hospital in South Brazil, Hospital de Clínicas de Porto Alegre (HCPA). Research design and methodology – we conducted a prospective cohort study of pregnant women, referred from public primary health care for treatment of GDM at HCPA, between 2008 and 2015. We searched associations of glycemic profiles to birth weight, large for gestational age newborn and adverse neonatal outcomes. Results – we followed 440 GDM women from diagnosis to delivery. Mean prepregnancy body mass index (BMI) was 33.3kg/m2; 351 babies (79.8%) had appropriate birth weight for gestational age. Mean glucose in pre-prandial and postprandial profiles increased with raising birth weight category. Three or more abnormal glycemic profiles showed the strongest association to a large baby (OR 3.15 1.51-6.55) and to a composite of adverse neonatal outcomes (OR 2.28 1.59- 3.29). Gestational weight gain in the course of treatment was associated to large babies, as pre-pregnancy BMI, the latter also an independent risk factor for adverse neonatal outcome. Conclusion – abnormal maternal glycemic profiles in more than two occasions were the stronger risk factor for delivering a large baby and for developing neonatal complications. A beneficial effect of GDM treatment, guided by glycemic profiles, was that most of our newborns had birth weight appropriate for gestational age, although incidence of adverse neonatal outcomes had been no different across birth weight categories.

Introdução e objetivos – A finalidade prioritária no tratamento do diabetes mellitus gestacional (DMG) é alcançar níveis de glicemia materna tão próximos da normalidade quanto possível, a fim de reduzir os efeitos adversos associados à hiperglicemia na gestação. A auto verificação da glicemia capilar (perfil glicêmico) é o método mais usado para a monitorização do controle metabólico na gestação complicada por diabetes. Nosso objetivo foi analisar as associações entre os perfis glicêmicos maternos com os principais desfechos da gestação numa população de mulheres com DMG acompanhadas em ambulatório de pré-natal especializado em hospital universitário no sul do Brasil, Hospital de Clínicas de Porto Alegre (HCPA). Desenho e metodotologia – conduzimos um estudo de coorte prospectiva de gestantes referidas da rede de atenção primária de saúde pública para tratamento do DMG no HCPA, acompanhadas do diagnóstico ao parto. Pesquisamos associações entre os resultados dos perfis glicêmicos com o peso de nascimento e com o risco de recém-nascidos grandes para idade gestacional e de desfechos adversos perinatais. Resultados – acompanhamos 440 mulheres com DMG. A média do índice de massa corporal (IMC) foi 33.3kg/m2. 351 bebês (79.8%) mostraram peso adequado à idade gestacional no nascimento. As médias de glicemia nos perfis pré e pósprandiais aumentaram com o avanço na categoria de peso nascimento. Três ou mais perfis glicêmicos anormais foram o fator de risco mais robusto para o nascimento de bebês grandes (OR 3.15 1.51-6.55) e para o desenvolvimento de desfechos adversos perinatais (OR 2.28 1.59-3.29). O ganho de peso materno durante o tratamento associou-se ao risco de recém-nascido grande para idade gestacional, assim como o IMC pré-gestacional, esse último também fator de risco independente para eventos perinatais adversos. Conclusão – perfis glicêmicos anormais em mais de 2 ocasiões foram o fator de risco mais relacionado ao nascimento de um bebê grande para a idade gestacional e para o desenvolvimento de complicações neonatais. Efeito benéfico do tratamento do DMG, guiado pelos perfis glicêmicos, foi a maioria de recém-nascidos com peso adequado à idade gestacional nessa coorte, apesar da incidência de desfechos perinatais adversos não ter sido diferente entre as categorias de peso fetal de nascimento. / Background and objective – a priority target in the treatment of gestational diabetes mellitus (GDM) is attaining maternal glucose levels as close as possible to euglycemia, in order to decrease the adverse outcomes linked to hyperglycemia. Self-performed capillary glucose (glycemic profile) is the most widely used method for metabolic monitoring in pregnancy complicated by diabetes. We intended to analyze the associations of maternal glycemic profile to main pregnancy outcomes in a population of GDM women treated in a specialized prenatal clinic at a university hospital in South Brazil, Hospital de Clínicas de Porto Alegre (HCPA). Research design and methodology – we conducted a prospective cohort study of pregnant women, referred from public primary health care for treatment of GDM at HCPA, between 2008 and 2015. We searched associations of glycemic profiles to birth weight, large for gestational age newborn and adverse neonatal outcomes. Results – we followed 440 GDM women from diagnosis to delivery. Mean prepregnancy body mass index (BMI) was 33.3kg/m2; 351 babies (79.8%) had appropriate birth weight for gestational age. Mean glucose in pre-prandial and postprandial profiles increased with raising birth weight category. Three or more abnormal glycemic profiles showed the strongest association to a large baby (OR 3.15 1.51-6.55) and to a composite of adverse neonatal outcomes (OR 2.28 1.59- 3.29). Gestational weight gain in the course of treatment was associated to large babies, as pre-pregnancy BMI, the latter also an independent risk factor for adverse neonatal outcome. Conclusion – abnormal maternal glycemic profiles in more than two occasions were the stronger risk factor for delivering a large baby and for developing neonatal complications. A beneficial effect of GDM treatment, guided by glycemic profiles, was that most of our newborns had birth weight appropriate for gestational age, although incidence of adverse neonatal outcomes had been no different across birth weight categories.

Introdução e objetivos – A finalidade prioritária no tratamento do diabetes mellitus gestacional (DMG) é alcançar níveis de glicemia materna tão próximos da normalidade quanto possível, a fim de reduzir os efeitos adversos associados à hiperglicemia na gestação. A auto verificação da glicemia capilar (perfil glicêmico) é o método mais usado para a monitorização do controle metabólico na gestação complicada por diabetes. Nosso objetivo foi analisar as associações entre os perfis glicêmicos maternos com os principais desfechos da gestação numa população de mulheres com DMG acompanhadas em ambulatório de pré-natal especializado em hospital universitário no sul do Brasil, Hospital de Clínicas de Porto Alegre (HCPA). Desenho e metodotologia – conduzimos um estudo de coorte prospectiva de gestantes referidas da rede de atenção primária de saúde pública para tratamento do DMG no HCPA, acompanhadas do diagnóstico ao parto. Pesquisamos associações entre os resultados dos perfis glicêmicos com o peso de nascimento e com o risco de recém-nascidos grandes para idade gestacional e de desfechos adversos perinatais. Resultados – acompanhamos 440 mulheres com DMG. A média do índice de massa corporal (IMC) foi 33.3kg/m2. 351 bebês (79.8%) mostraram peso adequado à idade gestacional no nascimento. As médias de glicemia nos perfis pré e pósprandiais aumentaram com o avanço na categoria de peso nascimento. Três ou mais perfis glicêmicos anormais foram o fator de risco mais robusto para o nascimento de bebês grandes (OR 3.15 1.51-6.55) e para o desenvolvimento de desfechos adversos perinatais (OR 2.28 1.59-3.29). O ganho de peso materno durante o tratamento associou-se ao risco de recém-nascido grande para idade gestacional, assim como o IMC pré-gestacional, esse último também fator de risco independente para eventos perinatais adversos. Conclusão – perfis glicêmicos anormais em mais de 2 ocasiões foram o fator de risco mais relacionado ao nascimento de um bebê grande para a idade gestacional e para o desenvolvimento de complicações neonatais. Efeito benéfico do tratamento do DMG, guiado pelos perfis glicêmicos, foi a maioria de recém-nascidos com peso adequado à idade gestacional nessa coorte, apesar da incidência de desfechos perinatais adversos não ter sido diferente entre as categorias de peso fetal de nascimento. / Background and objective – a priority target in the treatment of gestational diabetes mellitus (GDM) is attaining maternal glucose levels as close as possible to euglycemia, in order to decrease the adverse outcomes linked to hyperglycemia. Self-performed capillary glucose (glycemic profile) is the most widely used method for metabolic monitoring in pregnancy complicated by diabetes. We intended to analyze the associations of maternal glycemic profile to main pregnancy outcomes in a population of GDM women treated in a specialized prenatal clinic at a university hospital in South Brazil, Hospital de Clínicas de Porto Alegre (HCPA). Research design and methodology – we conducted a prospective cohort study of pregnant women, referred from public primary health care for treatment of GDM at HCPA, between 2008 and 2015. We searched associations of glycemic profiles to birth weight, large for gestational age newborn and adverse neonatal outcomes. Results – we followed 440 GDM women from diagnosis to delivery. Mean prepregnancy body mass index (BMI) was 33.3kg/m2; 351 babies (79.8%) had appropriate birth weight for gestational age. Mean glucose in pre-prandial and postprandial profiles increased with raising birth weight category. Three or more abnormal glycemic profiles showed the strongest association to a large baby (OR 3.15 1.51-6.55) and to a composite of adverse neonatal outcomes (OR 2.28 1.59- 3.29). Gestational weight gain in the course of treatment was associated to large babies, as pre-pregnancy BMI, the latter also an independent risk factor for adverse neonatal outcome. Conclusion – abnormal maternal glycemic profiles in more than two occasions were the stronger risk factor for delivering a large baby and for developing neonatal complications. A beneficial effect of GDM treatment, guided by glycemic profiles, was that most of our newborns had birth weight appropriate for gestational age, although incidence of adverse neonatal outcomes had been no different across birth weight categories.