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- Abordagem Nutricional e Dietética na Prevenção e Tratamento da Hipertensão ArterialPublication . Mendes, D; Marques da Silva, P
- Aspectos Nutricionais na Grávida Hipertensa e ObesaPublication . Lavinha, IA mulher que pensa engravidar deve possuir bons hábitos alimentares. O excesso de peso numa mulher grávida origina um aumento de complicações na gravidez como hipertensão arterial, diabetes, entre outros. Ensinar uma grávida a comer é ensinar a futura geração a comer. Vivemos numa sociedade em que a obesidade é o distúrbio alimentar mais comum, estando a aumentar a sua prevalência em todas as faixas etárias. Na consulta de hipertensão e gravidez na Maternidade Dr. Alfredo da Costa, verifica-se que as mulheres com obesidade representam o maior grupo, seguido do grupo das mulheres com excesso de peso e muito próximo na prevalência, a superobesidade.
- Chronic Hypertension with Gestational Diabetes Mellitus: What About Complications?Publication . Campos, A; Massa, AC; Rangel, R; Cardoso, M; Borges, AThe aim of this study was to evaluate the impact of chronic hypertension and gestational diabetes on pregnancy outcomes. We conducted a historical cohort study of 334 women undergoing singleton births in a Portuguese tertiary care center in Lisbon during 2012. Women were categorized into gestational diabetes mellitus with or without chronic hypertension. Pregnancy outcomes were compared using nonparametric tests. Multivariable analysis was used to control for potential confounders. The rate of preeclampsia in women with both chronic hypertension and gestational diabetes was 26.8% versus 3.8% in women with only gestational diabetes (p<0.05). Preterm birth was significantly more frequent in women with diabetes and chronic hypertension, 22.9% versus 9.7%, compared with women who only had gestational diabetes (p<0.05). The rate of newborns small for gestational age in women with the two conditions was 19.1% versus 7.6% in women with only gestational diabetes (p<0.05), but the rate of large for gestational age newborns in women of chronic hypertension and gestational diabetes was 9.6% versus 3.8% in gestational diabetes (p<0.05). The impact of having both chronic hypertension and gestational diabetes in pregnancy leads to poor pregnancy and perinatal outcomes, represented by more maternal, obstetrical and neonatal morbidity.
- Customized Human Milk Fortification Based on Measured Human Milk Composition to Improve the Quality of Growth in Very Preterm Infants: A Mixed-Cohort Study ProtocolPublication . Cardoso, M; Virella, D; Macedo, I; Silva, D; Pereira-da-Silva, LAdequate nutrition of very preterm infants comprises fortification of human milk (HM), which helps to improve their nutrition and health. Standard HM fortification involves a fixed dose of a multi-nutrient HM fortifier, regardless of the composition of HM. This fortification method requires regular measurements of HM composition and has been suggested to be a more accurate fortification method. This observational study protocol is designed to assess whether the target HM fortification method (contemporary cohort) improves the energy and macronutrient intakes and the quality of growth of very preterm infants, compared with the previously used standard HM fortification (historical cohorts). In the contemporary cohort, a HM multi-nutrient fortifier and modular supplements of protein and fat are used for HM fortification, and the enteral nutrition recommendations of the European Society for Paediatric Gastroenterology Hepatology and Nutrition for preterm infants will be considered. For both cohorts, the composition of HM is assessed using the Miris Human Milk analyzer (Uppsala, Sweden). The quality of growth will be assessed by in-hospital weight, length, and head circumference growth velocities and a single measurement of adiposity (fat mass percentage and fat mass index) performed just after discharge, using the air displacement plethysmography method (Pea Pod, Cosmed, Italy). ClinicalTrials.gov registration number: NCT04400396.
- Diabetes Gestacional e o Impacto do Actual RastreioPublication . Massa, AC; Rangel, R; Cardoso, M; Campos, AIntrodução: Em 2011, foi introduzido um novo rastreio para a diabetes gestacional que permitiu um diagnóstico mais precoce e de maior número de casos com o intuito de reduzir complicações maternas e perinatais. O objectivo deste estudo foi avaliar a prevalência da diabetes gestacional, comparar resultados obstétricos e perinatais do anterior e presente rastreio e os resultados e realização da prova de reclassificação pós-parto. Material e Métodos: Estudo retrospectivo em gestações simples e diabetes gestacional diagnosticados em 2009 (n = 223) e 2012 (n = 237), vigiadas na Maternidade Dr. Alfredo da Costa, Portugal. Após consulta de processos clínicos procedeu-se à análise de características demográficas, história médica e obstétrica, aumento ponderal durante a gravidez, idade gestacional do diagnóstico, terapêutica utilizada, resultados perinatais e reclassificação pós-parto, seguida de comparação destas variáveis entre os anos de 2009 e 2012. Resultados: Em 2012, houve maior prevalência de diabetes gestacional, ganho ponderal inferior (p < 0,001), maior recurso à terapêutica farmacológica (p < 0,001) e aumento dos casos diagnosticados no primeiro e segundo trimestres (p < 0,001). Relativamente aos resultados neonatais, o peso médio do recém-nascido ao nascer foi significativamente menor (p = 0,001) com diminuição dos recém-nascidos grandes para a idade gestacional (p = 0,002). A taxa de reclassificação pós-parto foi semelhante nos dois anos mas em 2012 houve um aumento dos resultados normais e diminuição das anomalias da glicémia em jejum. Discussão: Critérios mais apertados do actual rastreio permitiram a redução da maioria das complicações da diabetes gestacional levantando novas questões. Conclusão: A introdução do actual rastreio resultou num aumento de prevalência, diagnóstico mais precoce e redução da macrossomia.
- Eating Habits During Pregnancy of Women Giving Birth Very Prematurely: An Exploratory AnalysisPublication . Teixeira, B; Cardoso, M; Dias, CC; Pereira-da-Silva, L; E Silva, DIntroduction: Preterm birth is increasing worldwide, representing a major cause of death and long-term loss of human potential among survivors. Some morbidities during pregnancy are well-known risk factors for preterm labor, but it is not yet known whether deviations from adequate dietary patterns are associated with preterm delivery. Diet may be an important modulator of chronic inflammation, and pro-inflammatory diets during pregnancy were reported to be associated with preterm birth. The aim of this study was to assess the food consumption during pregnancy of Portuguese women giving birth very prematurely and the association between the food consumption and the major maternal morbidities during pregnancy related with preterm delivery. Material and methods: A single-center cross-sectional observational study including consecutive Portuguese women giving birth before 33 weeks of gestation was conducted. Recall of eating habits during pregnancy was obtained within the first week after delivery, using a semi quantitative food frequency questionnaire validated for Portuguese pregnant women. Results: Sixty women with a median age of 36.0 years were included. Of these, 35% were obese or overweight at the beginning of pregnancy, 41.7% and 25.0% gained excessive or insufficient weight during pregnancy, respectively. Pregnancy-induced hypertension was present in 21.7% of cases, gestational diabetes in 18.3%, chronic hypertension in 6.7%, and type 2 diabetes mellitus in 5.0%. Pregnancy-induced hypertension was significantly associated with increased daily consumption of pastry products (31.2 vs 10.0 g, p = 0.022), fast food (39.6 vs 29.7 g, p = 0.028), bread (90.0 vs 50.0 g, p = 0.005), pasta, rice and potatoes (225.7 vs 154.3 g, p = 0.012). In a multivariate analysis, only bread consumption maintained a significant, albeit weak, association (OR = 1.021; 1.003 - 1.038, p = 0.022). Conclusion: Pregnancy-induced hypertension was associated with increased consumption of pastry products, fast food, bread, pasta, rice, and potatoes, although only bread consumption had a weak but statistically significant association with pregnancy-induced hypertension in a multivariate analysis.
- Fat Mass Index Performs Best in Monitoring Management of Obesity in Prepubertal ChildrenPublication . Pereira-da-Silva, L; Pitta-Grós Dias, M; Dionísio, E; Virella, D; Alves, M; Diamantino, C; Alonso, A; Cordeiro-Ferreira, GAn early and accurate recognition of success in treating obesity may increase the compliance of obese children and their families to intervention programs. This observational, prospective study aimed to evaluate the ability and the time to detect a significant reduction of adiposity estimated by body mass index (BMI), percentage of fat mass (%FM), and fat mass index (FMI) during weight management in prepubertal obese children.
- FEEDMI: A Study Protocol to Determine the Influence of Infant-Feeding on Very-Preterm-Infant's Gut MicrobiotaPublication . Morais, J; Marques, C; Teixeira, D; Durão, C; Faria, A; Brito, S; Cardoso, M; Macedo, I; Tomé, T; Calhau, CBackground: Preterm infants are especially vulnerable to gut microbiota disruption and dysbiosis since their early gut microbiota is less abundant and diverse. Several factors may influence infants' gut microbiota, such as the mother's diet, mode of delivery, antibiotic exposure, and type of feeding. Objectives: This study aims to examine the factors associated with very-preterm neonate's intestinal microbiota, namely: (1) type of infant-feeding (breast milk, donor human milk with or without bovine protein-based fortifier, and preterm formula); (2) maternal diet; and (3) mode of delivery. Methods: This is an observational study conducted in a cohort of very preterm infants hospitalized in the neonatal intensive care unit of Maternidade Dr. Alfredo da Costa. After delivery, the mothers are asked to collect their own fecal samples and are invited to complete a semiquantitative food frequency questionnaire. The maternal diet will be classified in accordance to the Mediterranean Diet adherence score. Stool samples have been collected from very premature infants every 7 days for 21 days. DNA has been extracted from the fecal samples, and different bacterial genus and species will be quantified by real-time polymerase chain reaction. Results and conclusions: It is hypothesized that significant differences in the microbiota composition and clinical outcomes of very preterm infants will be observed depending on the type of infant feeding. In addition, this study will clarify how pasteurized donor's milk influences the intestinal microbiota colonization of preterm infants. This is a pioneer study developed in collaboration with the country's Human Milk Bank. We also expect to find microbiota alterations in infants according to the mode of delivery and to maternal diet. This study will contribute to increase the evidence on the effects of breast or donor human milk and its fortification with a bovine protein-based fortifier on infant microbiota.
- Individualized Fortification Based on Measured Macronutrient Content of Human Milk Improves Growth and Body Composition in Infants Born Less than 33 Weeks: A Mixed-Cohort StudyPublication . Cardoso, M; Virella, D; Papoila, AL; Alves, M; Macedo, I; e Silva, D; Pereira-da-Silva, LThe optimal method for human milk (HM) fortification has not yet been determined. This study assessed whether fortification relying on measured HM macronutrient content (Miris AB analyzer, Upsala, Sweden) composition is superior to fortification based on assumed HM macronutrient content, to optimize the nutrition support, growth, and body composition in infants born at <33 weeks' gestation. In a mixed-cohort study, 57 infants fed fortified HM based on its measured content were compared with 58 infants fed fortified HM based on its assumed content, for a median of 28 and 23 exposure days, respectively. The ESPGHAN 2010 guidelines for preterm enteral nutrition were followed. Growth assessment was based on body weight, length, and head circumference Δ z-scores, and the respective growth velocities until discharge. Body composition was assessed using air displacement plethysmography. Fortification based on measured HM content provided significantly higher energy, fat, and carbohydrate intakes, although with a lower protein intake in infants weighing ≥ 1 kg and lower protein-to-energy ratio in infants weighing < 1 kg. Infants fed fortified HM based on its measured content were discharged with significantly better weight gain, length, and head growth. These infants had significantly lower adiposity and greater lean mass near term-equivalent age, despite receiving higher in-hospital energy and fat intakes, with a mean fat intake higher than the maximum recommended and a median protein-to-energy ratio intake (in infants weighing < 1 kg) lower than the minimum recommended.
- Influence of Human Milk on Very Preterms' Gut Microbiota and Alkaline Phosphatase ActivityPublication . Morais, J; Marques, C; Faria, A; Teixeira, D; Barreiros-Mota, I; Durão, C; Araújo, J; Ismael, S; Brito, S; Cardoso, M; Macedo, I; Pereira, E; Tomé, T; Calhau, CThe FEEDMI Study (NCT03663556) evaluated the influence of infant feeding (mother's own milk (MOM), donor human milk (DHM) and formula) on the fecal microbiota composition and alkaline phosphatase (ALP) activity in extremely and very preterm infants (≤32 gestational weeks). In this observational study, preterm infants were recruited within the first 24 h after birth. Meconium and fecal samples were collected at four time points (between the 2nd and the 26th postnatal days. Fecal microbiota was analyzed by RT-PCR and by 16S rRNA sequencing. Fecal ALP activity, a proposed specific biomarker of necrotizing enterocolitis (NEC), was evaluated by spectrophotometry at the 26th postnatal day. A total of 389 fecal samples were analyzed from 117 very preterm neonates. Human milk was positively associated with beneficial bacteria, such as Bifidobacterium, Bacteroides ovatus, and Akkermancia muciniphila, as well as bacterial richness. Neonates fed with human milk during the first week of life had increased Bifidobacterium content and fecal ALP activity on the 26th postnatal day. These findings point out the importance of MOM and DHM in the establishment of fecal microbiota on neonates prematurely delivered. Moreover, these results suggest an ALP pathway by which human milk may protect against NEC.