Teses / dissertações sobre o tema "Pregnancy Nutritional aspects"

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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
Objetivo: delinear, implementar e avaliar a efetividade de uma intervenção - inserção sistematizada da promoção da alimentação saudável e caminhada no lazer na atenção pré-natal rotineira realizada por médicos e enfermeiros em unidades de saúde da família - sobre cinco práticas alimentares e a realização de caminhada no lazer por gestantes. Métodos: estudo de intervenção controlado, não randomizado, no qual participaram 42 médicos/enfermeiros e uma amostra (n=353) de gestantes por eles assistidas em unidades de atenção primária à saúde da rede pública do município de Botucatu-SP, Brasil. O estudo foi dividido em duas etapas: avaliação das mudanças em conhecimentos e práticas dos profissionais e avaliação do impacto da intervenção sobre os comportamentos das gestantes por eles assistidas. Na primeira, foi delineada e implementada uma ação educativa (AE), com 16 horas, presenciais, dirigida a médicos e enfermeiros que assistem gestantes em 9 unidades de saúde da família, com o objetivo de ampliar/adequar seus conhecimentos sobre alimentação e atividade física na gestação e organizar o processo de trabalho para a inserção sistematizada no pré-natal da promoção de 5 práticas alimentares (3 frutas diariamente; 2 porções de hortaliças e 2 de feijão, pelo menos em 5 dias da semana; consumo esporádico (no máximo uma vez por semana) de refrigerante e/ou biscoito industrializado) e da orientação das gestantes para a realização de caminhada no lazer. A AE incluiu um curso de imersão (8hs) com todos os profissionais e 3 oficinas de trabalho em cada unidade de saúde. Os conhecimentos e práticas dos participantes (n=22), antes e após a intervenção, foram comparados aos de um grupo controle (n=20), formado pelos profissionais de 8 unidades básicas de saúde de modelo tradicional (UBS) situadas no mesmo município e que não foram envolvidas na intervenção. Nos dois grupos, os conhecimentos...
Objective: to design, implement and evaluate the effectiveness of an intervention - systematic insertion of promoting healthy eating and leisure-time walking during in routine prenatal care performed by doctors and nurses in family health care units - over five dietary practices and the realization of leisure-time walking at by pregnant women. Methods: this is a controlled intervention study, not randomized, in which took part 42 doctors/nurses and a sample (n=353) of pregnant women attended by those professionals in primary health care settings to public health care in the city of Botucatu-SP, Brazil. The study has been divided into two stages. The first one was the implementation and evaluation of an educational activity (EA), with 16 hours, by attendance, addressed to doctors and nurses who assist pregnant women in nine family health care units, in order to extend/adapt their knowledge of nutrition and physical activity during pregnancy and then introduce routinely and systematically in prenatal care the promotion of 5 dietary practices (3 fruit daily; 2 servings of vegetables and two servings of beans, at least 5 days a week; sporadic consumption (maximum once a week) of soda and / or industrialized cookie), and guidance of pregnant women to walking during leisure time. The knowledge and practices of the participants (n=22) before and after the EA, have been compared to a control group (n=20), formed by professionals of eight traditional health care units not involved in the educational activity. This knowledge has been evaluated in both groups with a self-applied questionnaire, elaborated for this research; practices (guidance for leisure-time walking and healthy eating) have been measured by interviews with pregnant women assisted by two professional groups, in their homes. We have generated two scores of knowledge (about walking and nutrition) and we have used ANOVA for repeated measures to assess changes before and after the ...

Orientador: Maria Antonieta de Barros Leite Carvalhães
Coorientador: Maria Helena D'Aquino Benício
Banca: Daniela Saes Sartorelli
Banca: Luiza Cristina Godim Domingues Dias
Banca: Paula Andrea Martins
Banca: Silvia Justina Papini
Resumo: Objetivo: delinear, implementar e avaliar a efetividade de uma intervenção - inserção sistematizada da promoção da alimentação saudável e caminhada no lazer na atenção pré-natal rotineira realizada por médicos e enfermeiros em unidades de saúde da família - sobre cinco práticas alimentares e a realização de caminhada no lazer por gestantes. Métodos: estudo de intervenção controlado, não randomizado, no qual participaram 42 médicos/enfermeiros e uma amostra (n=353) de gestantes por eles assistidas em unidades de atenção primária à saúde da rede pública do município de Botucatu-SP, Brasil. O estudo foi dividido em duas etapas: avaliação das mudanças em conhecimentos e práticas dos profissionais e avaliação do impacto da intervenção sobre os comportamentos das gestantes por eles assistidas. Na primeira, foi delineada e implementada uma ação educativa (AE), com 16 horas, presenciais, dirigida a médicos e enfermeiros que assistem gestantes em 9 unidades de saúde da família, com o objetivo de ampliar/adequar seus conhecimentos sobre alimentação e atividade física na gestação e organizar o processo de trabalho para a inserção sistematizada no pré-natal da promoção de 5 práticas alimentares (3 frutas diariamente; 2 porções de hortaliças e 2 de feijão, pelo menos em 5 dias da semana; consumo esporádico (no máximo uma vez por semana) de refrigerante e/ou biscoito industrializado) e da orientação das gestantes para a realização de caminhada no lazer. A AE incluiu um curso de imersão (8hs) com todos os profissionais e 3 oficinas de trabalho em cada unidade de saúde. Os conhecimentos e práticas dos participantes (n=22), antes e após a intervenção, foram comparados aos de um grupo controle (n=20), formado pelos profissionais de 8 unidades básicas de saúde de modelo tradicional (UBS) situadas no mesmo município e que não foram envolvidas na intervenção. Nos dois grupos, os conhecimentos...
Abstract: Objective: to design, implement and evaluate the effectiveness of an intervention - systematic insertion of promoting healthy eating and leisure-time walking during in routine prenatal care performed by doctors and nurses in family health care units - over five dietary practices and the realization of leisure-time walking at by pregnant women. Methods: this is a controlled intervention study, not randomized, in which took part 42 doctors/nurses and a sample (n=353) of pregnant women attended by those professionals in primary health care settings to public health care in the city of Botucatu-SP, Brazil. The study has been divided into two stages. The first one was the implementation and evaluation of an educational activity (EA), with 16 hours, by attendance, addressed to doctors and nurses who assist pregnant women in nine family health care units, in order to extend/adapt their knowledge of nutrition and physical activity during pregnancy and then introduce routinely and systematically in prenatal care the promotion of 5 dietary practices (3 fruit daily; 2 servings of vegetables and two servings of beans, at least 5 days a week; sporadic consumption (maximum once a week) of soda and / or industrialized cookie), and guidance of pregnant women to walking during leisure time. The knowledge and practices of the participants (n=22) before and after the EA, have been compared to a control group (n=20), formed by professionals of eight traditional health care units not involved in the educational activity. This knowledge has been evaluated in both groups with a self-applied questionnaire, elaborated for this research; practices (guidance for leisure-time walking and healthy eating) have been measured by interviews with pregnant women assisted by two professional groups, in their homes. We have generated two scores of knowledge (about walking and nutrition) and we have used ANOVA for repeated measures to assess changes before and after the ...
Doutor

To study the effect of exercise and protein intake during pregnancy on maternal and fetal zinc status in the rat, one hundred and seventy-nine pregnant Sprague-Dawley rats were divided into four groups; sedentary-standard protein diet, sedentary-high protein diet, exercising-standard protein diet and exercising-high protein diet. The standard protein diet contained 7.22% protein, while the high protein diet contained 24.77% protein; all other nutrients were supplied in amounts required for normal parturition of the laboratory rat. After acclimatization, the exercising dams, regardless of diet, were made to swim continuously for one and one-half hours/day until sacrifice. The four major groups were further subdivided into 28 groups, designated by three-day intervals according to gestational day--days 3, 6, 9, 12, 15, 18, and 21. Uterine tissues were retained for zinc content analysis; fetal and placental tissues were separated from uterine tissue for days 15 through 21 only. The concentration of uterine zinc was affected solely by gestation; absolute placental tissue zinc values were lowest in the sedentary-high and exercising-low protein groups, while the exercising-high protein group possessed the greatest zinc value. No significant difference was detected in fetal zinc concentrations. Fetal tissue from exercising dams weighed significantly less (p<0.05) than fetal tissue from the sedentary dams; and sedentary-high protein dams produced significantly more (p<0.05) fetuses than the exercising-high protein dams. Both protein intake and exercising during pregnancy significantly affect normal parturition and zinc metabolism in the rat.
M.S.

Includes bibliographical references (leaves 228-257). Aims to determine the impact of maternal undernutrition during late gestation and during the periconceptional and gestational periods on fetal growth, fetal blood pressure and the fetal hypothalamo-pituitary adrenal axis in the sheep.

Many of the known risk factors associated with low birth weight, such as socio-economic status, ethnicity, genetic makeup, and obstetric history, are not within a women's immediate control. However, there are many things that a woman can do to improve her chances of having a normal healthy child. Lifestyle behaviours, such as cigarette smoking, nutrition and the use of alcohol, play an important role in determining the growth of the fetus. The aim of this study was to establish the knowledge, attitudes and practices related to lifestyle factors such as alcohol use, smoking and nutrition among childbearing women and health care workers on the farms in Stellenbosch and Vredendal.

To test the hypothesis that maternal dietary glucose restriction throughout pregnancy and lactation would perturb glucose transporter (GLUT) protein levels in offspring, isoenergetic diets containing graded levels of glucose (0, 12, 24 and 60%) were fed to pregnant rats and their offspring from gestation day (gd) 0 through postnatal day (pd) 49. Diets were defined as deficient (0%), restricted (12, 24%) or adequate (60%) in glucose. Plasma, small intestine, liver and kidney tissues were collected perinatally (gd20, birth, 12--24hrs postnatal), during lactation (pd7, 15, 21), post-weaning (pd28, 35, 49) and in adult controls. The proximal and distal regions of the small intestine responded differently to the dietary glucose restriction. Proximal small intestine GLUT2 protein levels did not change throughout postnatal development and remained unaltered with dietary glucose restriction, while distal small intestine GLUT2 protein expression changed throughout postnatal development and with dietary glucose restriction. These findings, together with information from the literature, indicate a dissociation between small intestine GLUT2 mRNA expression, GLUT2 protein levels and small intestine glycogen reserves.

The purpose of these studies was to investigate the impact of high-fat diet (HFD) exposure during pregnancy and the early post-natal period on fetal and post-natal development of the endocrine pancreas of the Japanese macaque. Specifically I hypothesized that the HFD would alter islet morphology and lead to disturbances in glucose homeostasis in these animals. Adult female Japanese macaques were placed on either a control (CTR) or HFD diet for 4 years. Fetuses were collected at gestational day 130 (G130), while other offspring from the CTR and HFD mothers were carried to term. After birth, infant animals were maintained with their mothers on the same diet then weaned onto either the CTR or HFD diet for five months. Animals were studied up to 13 months of age, yielding 4 postnatal groups: CTR/CTR, CTR/HFD, HFD/CTR and HFD/HFD. Pancreata were collected from these offspring for gene expression and immunohistochemical analysis. Physiological measurements, including body weight, body fat percentage, fasting glucose, insulin, glucagon and response to intravenous glucose tolerance tests (IVGTTs) and an intravenous insulin tolerance test (IVITT) were collected from the post-natal offspring. Total fetal islet mass and β cell mass were not changed, but α cell mass was significantly decreased in HFD fetuses, leading to a significant increase in the β cell to α cell ratio in HFD fetal offspring. The HFD offspring displayed a significant change from CTR offspring in expression of genes involved in glucose homeostasis and islet neogenesis, including PDX1, NeuroD, Glucokinase and Glut2. Postnatal HFD animals were significantly heavier than CTR offspring and had increased adiposity by 6-7 months of age. There was no significant effect on fasting or stimulated insulin secretion at this time point, but HFD offspring were significantly insulin resistant just prior to weaning. At 13 months of age, basal and glucose-stimulated insulin secretion were elevated in HFD/HFD animals and the CTR/HFD group displayed moderate insulin resistance. There was also a significant sex effect, with males from the HFD/CTR and HFD/HFD group having increased body weight and elevated fasting glucose. Although pancreata from both the HFD/HFD and CTR/HFD animals displayed significant changes in expression of genes involved in glucose homeostasis, the pattern was distinct for the two groups. Islet mass was also elevated in both of these groups; yet, HFD/HFD only displayed an increase in β cell area, while CTR/HFD had a concomitant increase in α cell area, which served to normalize the β cell to α cell ratio to control levels. In contrast, the HFD/HFD group exhibited a 40% increase in the β cell to α cell ratio. These studies demonstrate that in-utero exposure to a HFD leads to decreased α cell plasticity in response to chronic post-natal HFD consumption. Animals exposed to the HFD during pregnancy and the early post-natal period become insulin resistant, but remain normoglycemic. HFD consumption during the post-weaning period causes similar complications in glucose homeostasis and islet mass in both the CTR/HFD and HFD/HFD animals. However, there are distinct differences in the molecular and cellular adaptive response between these two groups.

This study was done with the objective of designing and applying a nutrition education program based on a test of improved practices for pregnant women and women of childbearing age in the rural communities of Ibarra canton: La Riconada and Cuambo. For this, information was collected on knowledge, attitudes, and practices (KAP) regarding the eating habits of pregnant women. These results were used to identify content and recommendations to reinforce and/or instruct about eating during pregnancy. Nutrition education was based on the methodology of the improved practices test, which consisted of testing the recommendations in families' homes before recommending them and recording information on their acceptability. The results indicate that pregnant women in the two communities don't eat all the food groups every day. They need to increase the consumption of foods rich in calcium and iron, as well as foods that supply energy, protein, and fats. The pregnant women don't eat additional foods to cover these recommendations during the pregnancy. Despite the knowledge they have and the lessons they received, there are women who don't eat greens, vegetables, and fruits because they don't like them, and those who do eat them don't meet the established nutritional recommendations. The women prefer to eat artificial drinks with unboiled water, and they do not look after personal hygiene. The test of improved practices has been useful for observing if they really put in practice the knowledge about eating during pregnancy, and at the same time it helped design the educational proposal that served as a guide to help improve eating practices of pregnant women in the two rural communities, considering their motivations and recommendations.

Background: Cigarette smoking is a leading preventable factor associated with complications in pregnancy including preterm birth and low birthweight. Past interventions have raised cessation rates by approximately 6% overall (Lumley et al. 2009). Methods: A three-part literature review, two qualitative studies with a total of 36 participants, and the development of an intervention to promote smoking cessation during pregnancy were completed. Central to the design of the research was the creation of the theoretical basis which was developed in line with recommendations from the MRC Framework for Complex Interventions (Craig et al. 2008, Campbell et al. 2000). For part one of the literature review, 24 qualitative and 44 quantitative studies were re-analysed to complete a mixed-methods secondary analysis of the active ingredients in interventions to promote smoking cessation during pregnancy. Part two consisted of an exploration of psychological models and constructs which are likely to predict or influence smoking behaviour during pregnancy. The final part was a discussion regarding the modes of delivery by which an intervention could feasibly be delivered. Qualitative interviews were carried out with participants from stakeholder groups to fill in gaps in literature and determine the acceptability and feasibility of the proposed intervention. The intervention was created using the theoretical basis developed from the findings. Further qualitative interviews, a focus group, and heuristic evaluation were used to determine the acceptability and usability of the intervention for the target group of pregnant smokers. Results and Conclusions: Findings from this work are potentially relevant for a wide range of behaviours and behavioural interventions. An intervention which has a strong grounding in theory and evidence, and is acceptable and feasible for the target group and in clinical practice was developed using evidence gathered in this thesis.

In 2011, African Americans in Tarrant County, Texas experienced an infant mortality rate of 14.3 per 1,000 live births. The leading cause of infant mortality in Tarrant County is prematurity and maternal nutritional status. Both maternal under-nutrition and over-nutrition are known risk factors for premature birth. Improving maternal nutrition, by reducing rates of gestational diabetes and preeclampsia, and by increasing consumption of essential prenatal vitamins and nutrients, is a road to decreasing preterm birth in African Americans. This qualitative study, based on both anthropology and public health theory, of the nutrition behavior of a group of African American expectant mothers and the experience of their health care providers and co-facilitators had a goal to provide a foundation for future development of nutrition behavior research and education for this specific population. The main finding of this study was the substantial gap of lived experience and education between the patients and their providers and co-facilitators, which hinders delivery of care and the patients’ acquiescence to nutrition recommendations. The discrepancies between the authoritative knowledge of the providers and the bodily knowledge of expectant mothers were responsible for the ineffectiveness of nutrition recommendations.

Background: Prenatal alcohol consumption is one of the leading preventable causes of birth defects, including fetal alcohol syndrome and learning disabilities. Although there is strong evidence of the benefits of screening and alcohol brief interventions (ABIs) in reducing hazardous and harmful drinking among the primary care population, evidence of its effectiveness with the antenatal care population is limited. Nevertheless, the Scottish Government is incorporating an alcohol screening and ABI programme as part of the routine antenatal care provided to women in a bid to protect the health and safety of the unborn child and improve subsequent health and developmental outcomes. This research therefore seeks to increase understanding of the factors that are likely to influence the effectiveness of this recently implemented programme. It also aims to explore the extent to which contemporary issues such as change in guidelines regarding alcohol consumption during pregnancy influences perceptions and attitudes, and the possible implications of these on the screening and ABI delivery. Methods: The study described in this thesis employed a realistic evaluation methodology. Realistic evaluation is a theory-driven approach to investigating social programmes. It is concerned with hypothesising, testing and refining programme theories by exploring the interaction of contexts, mechanisms and outcomes. To identify the relevant screening and ABI programme theories, two separate systematic reviews, a critical review and four face-to-face interviews were undertaken with health policy implementers. The findings were used to construct context, mechanism and outcomes propositions. The propositions were then tested by conducting individual interviews with seventeen pregnant women and fifteen midwives, a further six midwifery team leaders were involved in a focus group discussion. A thematic approach using a hybrid of inductive and deductive coding and theme development informed the qualitative analysis. Results: In the context of uncertainties regarding the threshold of drinking that causes fetal harm, pregnant women reported that screening assessment helped them to reflect on their drinking behaviour and facilitate behaviour change. For women who drank at hazardous and harmful levels before attending the booking appointment, screening and ABI may be helpful in terms of eliciting behaviour change. However, they may not be very beneficial in terms of reducing harm to the fetus as it has been found that drinking during the first trimester poses the most risk to the fetus. Training and resources provided to midwives as part of the screening and ABI programme were found to be facilitating mechanisms that midwives indicated improved their skills and confidence. However, most of the midwives had not subsequently employed the motivational interviewing skills required for the ABI delivery, as many of the pregnant women reported that they reduced or abstained from alcohol consumption once pregnancy was confirmed. The outcome noted was that midwives confidence decreased leading to missed opportunities to appropriately deliver the ABI to eligible women. The small numbers of women being identified for ABI meant midwives rarely delivered the ABI. This negatively influenced midwives attitudes as they then accorded ABI low priority in their workload. Other disenabling mechanisms noted to be hampering the implementation of the screening and ABI initiative included midwives contending with competing priorities at the booking appointments, and the lack of adequate rapport between midwives and pregnant women at the booking appointment to discuss alcohol issues appropriately, leading to women providing socially desirable responses to screening questions. Conclusions: The findings of this study has generated greater explanations of the working of the screening and ABI programme in antenatal care setting and has provided transferable lessons that can be used by others intending to implement similar programmes in other settings.

The aim of this research was to examine differences in general nutrition knowledge and prenatal sources of infant feeding information among women planning to feed breast milk, breast-milk substitutes, or a combination of breast milk and breast-milk substitutes. Subjects completed a demographic survey, a test of nutrition knowledge, and a questionnaire on sources of infant feeding information. There were no statistical differences in age, education, and nutrition knowledge scores among women in the three groups. A significant relationship was observed between education and nutrition knowledge; women who had attended college courses scored higher.003) on the nutrition knowledge test than those who had not attended. Health care providers (82%) and reading materials (82%) were the most frequently cited sources of infant feeding information. While general nutrition knowledge appears to be positively related to education, it does not appear to influence the infant feeding decision.
Department of Family and Consumer Sciences

Thesis (MNutr)--Stellenbosch University, 2012.
ENGLISH ABSTRACT: Background: Nausea and vomiting during pregnancy (NVP) is a common medical condition. Due to possible harmful side-effects that conventional medicine may pose to the fetus, many mothers choose not to use it, and are left helpless against NVP. There is a need for alternative treatment to relieve NVP symptoms. Objectives: This systematic review (SR) investigated current evidence regarding ginger for the treatment of NVP. The primary objective was to assess the effectiveness of ginger in treating NVP. The secondary objective was to assess the safety of ginger during pregnancy, by identifying adverse events or side-effects. Search strategy: Electronic search of bibliographic databases (1966-February 2011). Selection criteria: Randomized controlled trials (RCTs) of the efficacy of ginger by any route, as treatment for NVP in pregnant women regardless of their age or stage of pregnancy. Data collection and analysis: The principal investigator and independent reviewer individually identified relevant studies, extracted data and assessed trial quality. Data analysis was performed using the RevMan5 software. Differences at the level of p<0.05 were considered to be statistically significant. Results: Eleven RCTs involving 1176 pregnant women were included. The quality of evidence was low, hence the high risk of bias and imprecision of results. Ginger significantly improved the symptoms of nausea when compared to placebo, when comparing the results of this SR to past SRs, and taking into account a meta-analysis performed on two relatively large included studies (mean difference (MD) 1.20, 95% confidence interval (CI) 0.56-1.84, p=0.0002, I2=0%). However, another meta-analysis on two smaller studies indicated no significant improvement in nausea. Ginger did not significantly improve nausea when compared to vitamin B6 (MD 0.34, 95% CI -1.52-2.20, p=0.7, I2=91%). Similarly, ginger did not significantly reduce the number of vomiting episodes during NVP, when compared to placebo, although there was a trend towards improvement (MD 0.72, 95% CI -0.03-1.46, p=0.06, I2=71%). Subgroup analyses performed seemed to favor the lower daily dosage of <1500mg ginger to possibly be more effective for the relief of nausea. Ginger did not pose a significant risk for spontaneous abortion when compared to placebo (RR 3.14, 95% CI 0.65-15.11, p=0.15; I2=0%), or to vitamin B6 (RR 0.49, 95% CI 0.17-1.42, p=0.19, I2=40%). Similarly, ginger did not pose a significant risk for the side effects of heartburn or drowsiness when compared to placebo or vitamin B6. When compared to dimenhydrinate, ginger posed a smaller risk for drowsiness (RR 0.08, 95% CI 0.03-0.18) and no increased risk for heartburn. Conclusions: This review suggests potential benefits of ginger in reducing nausea symptoms in pregnancy (bearing in mind the limited number of studies, variable outcome reporting and quality of evidence). Ginger did not have a significant impact on vomiting episodes, nor pose a risk for side effects or adverse events during pregnancy. Based on evidence from this SR, ginger could be considered a harmless and possibly effective alternative option for women suffering from the symptoms of NVP. Large RCTs are necessary to confirm the possible benefit of ginger as treatment for NVP.
AFRIKAANSE OPSOMMING: Agtergrond: Naarheid en vomering tydens swangerskap (NVS) is ‘n algemene mediese toestand. As gevolg van moontlike skadelike newe-effekte wat konvensionele medikasie kan veroorsaak vir die fetus, vermy baie moeders dit en word hulpeloos gelaat teen NVS. Dus is daar behoefte aan alternatiewe behandeling vir NVS. Doelwitte: Hierdie sistematiese literatuuroorsig (SO) het huidige literatuur ondersoek wat verband hou met gemmer vir behandeling van NVS. Die primêre doelwit was om effektiwiteit van gemmer as behandeling vir NVS te assesseer. Die sekondêre doelwit was om veiligheid van gemmer tydens swangerskap te assesseer, deur ongunstige gebeure en newe-effekte te identifiseer. Soektogstrategie: Elektroniese soektog van bibliografiese databasisse (1966-Februarie 2011). Seleksiekriteria: Verewekansigde gekontrolleerde proewe (RCTs) van gemmer deur enige roete as behandeling van NVS, in swanger vroue ongeag ouderdom of stadium van swangerskap. Dataversameling en –analise: Die hoof navorser en ‘n onafhanklike hersiener het individueel relevante studies geidentifiseer, data ekstraksie onderneem en studie-kwaliteit geassesseer. Data-analise is uitgevoer deur die RevMan5 sagteware te gebruik. Verskille by die vlak van p<0.05 was beskou as statisties betekenisvol. Hoof resultate: Elf RCTs waarby 1176 swanger vroue betrokke was, is ingesluit. Die studie-kwaliteit was swak, dus die hoë risiko vir sydigheid en onakkuraatheid van resultate. Gemmer het beduidend die simptome van naarheid verbeter in vergelyking met plasebo, wanneer die resultate van hierdie SO met vorige SO’s vergelyk word, en die meta-analise in ag geneem word wat op twee relatiewe groot ingeslote studies uitgevoer is (gemiddelde verskil (MD) 1.20, 95% vertrouens interval (VI) 0.56-1.84, p=0.0002,I2=0%). Kontrasterend, het ‘n ander meta-analise van twee kleiner studies geen beduidende verbetering in naarheid aangedui nie. Gemmer het nie beduidend naarheid verbeter wanneer dit met vitamien B6 vergelyk word nie (MD 0.34, 95% VI -1.52-2.20, p=0.7, I2=91%). Soortgelyk, het gemmer nie die aantal vomerings-episodes verminder, in verglyking met plasebo nie, maar daar was wel ‘n neiging na verbetering (MD 0.72, 95% VI -0.03-1.46, p=0.06, I2=71%). Die subgroup-analise blyk ten gunste te wees van die laer daaglikse dosis van <1500mg gemmer om meer effektief te wees vir die behandeling van naarheid. Gemmer het nie ‘n beduidende risiko ingehou vir spontane aborsie, wanneer dit vergelyk word met plasebo (relatiewe risiko (RR) 3.14, 95% VI 0.65-15.11,p=0.15;I2=0%), of vitamien B6 nie (RR 0.49, 95% VI 0.17-1.42,p=0.19;I2=40%). Soortgelyk, het gemmer nie ‘n beduidende risiko ingehou vir newe-effekte van sooibrand of duiseligheid, wanneer dit vergelyk word met plasebo of vitamien B6 nie. Wanneer dit vergelyk word met dimenhidrinaat, het gemmer ‘n kleiner risiko ingehou vir duiseligheid (RR 0.08, 95% VI 0.03-0.18) en geen verhoogde risiko vir sooibrand nie. Gevolgtrekkings: Hierdie SO dui ‘n potensiële voordeel van gemmer aan in vermindering van naarheid tydens swangerskap (inagnemend van die klein hoeveelheid studies, wisselende uitkomste-rapportering en studie-kwaliteit). Gemmer het nie ‘n beduidnede impak gehad op vomerings-episodes nie, en ook nie ‘n risiko ingehou vir newe-efekte of ongunstige gebeure tydens swangerskap nie. Volgens bewyse uit hierdie SO, kan gemmer beskou word as ‘n skadelose en moontlike effektiewe alternatiewe opsie vir vroue wat lei aan NVP. Grootskaalse RCTs is nodig om die moontlike voordeel van gemmer as behandeling vir NVS te bevestig.

Orientador: Maria Cristina Cintra Gomes Marcondes
Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Biologia
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Resumo: Câncer acomete, aproximadamente, uma entre 3000 gravidezes e causa um terço de mortes maternas. A leucina é usada experimentalmente para minimizar as alterações do metabolismo protéico durante o crescimento tumoral. Este trabalho investigou os efeitos do crescimento tumoral sobre o metabolismo protéico e estresse oxidativo nos fetos provenientes de ratas alimentadas com dieta suplementada com leucina. Os grupos de fêmeas prenhes foram divididos da seguinte forma: controle (C), controle com dieta suplementada com leucina (L), tumor (W), tumor com dieta suplementada com leucina (WL), dieta pareada á ingestão diária das ratas do grupo W (Cp), dieta suplementada com leucina e pareada á ingestão diária das ratas do grupo WL (Lp). Após 20 dias de prenhes os músculos fetais foram analisados. Os resultados mostraram que a síntese protéica fetal foi reduzida no grupo W quando comparados aos outros grupos. Houve significativa recuperação da síntese protéica no músculo dos fetos WL sugerindo efeito positivo do uso de aminoácido de cadeia ramificada nessa situação. Ocorreu aumento significativo da degradação protéica nos fetos W. Essa perda protéica foi amenizada pelo uso da dieta suplementada com leucina indicando efeito benéfico sobre a degradação protéica no grupo WL que obteve valores similares ao observado no grupo C. A atividade da enzima glutationa-S-transferase ficou elevada no músculo de fetos WL em comparação com o grupo W. Também houve aumento na atividade da enzima fosfatase alcalina no grupo WL indicando maior atividade celular nesse grupo quando comparado ao grupo W. A presença de MDA (Malondialdeído) no músculo fetal também ficou reduzida nos fetos WL. Com a análise desses parâmetros conclui-se que a dieta suplementada com leucina pode alterar o metabolismo muscular fetal aumentando a síntese protéica e reduzindo o efeito danoso do estresse oxidativo.
Abstract: Cancer occurs in approximately 1 per 3.000 pregnancies and accounts for one-third of maternal deaths. Leucine has been used experimentally to minimize the protein metabolism changes during tumor growth. The present work investigated the effects of tumor growth on muscle protein metabolism and oxidative stress in fetus pregnant rats fed a leucine-rich diet. Fetal groups from pregnant Wistar rats were: control (C), control fed leucine-rich diet (L), tumor-bearing (W), tumor-bearing fed leucine-rich diet (WL), Pair-fed control (P) and Pair-fed Leucine (PL). After 20 days the fetal muscles were analyzed. The results showed that fetal protein synthesis was decreased in W group, when compared to the other groups. The significantly recover on muscle protein synthesis in fetus of WL group suggested a positive effect of this branched-chain amino acid. There was a significant increase on protein degradation in W fetus and a protective effect of the leucine-rich diet on muscle protein waste in WL group, since it was similar to C group. The muscle enzyme glutathione-S-transferase activity was increased in WL fetus in comparison to W group. The muscle alkaline phosphatase activity increased in WL group. The malondialdehyde content (MDA) in fetal muscle was decreased in WL fetus. The leucine supplemented diet can alter the fetal muscle protein metabolism, improving the fetal muscle protein synthesis and reducing the oxidative stress.
Mestrado
Fisiologia
Mestre em Biologia Funcional e Molecular

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Fundação de Ensino e Pesquisa em Ciências da Saúde (FEPECS)
A nutrição adequada é importante na gestação e, sobretudo, naquelas complicadas pelo diabete. Avaliar o consumo alimentar, pelo Índice de Qualidade de Dieta (IQD), em gestantes portadoras de Diabetes Melito Gestacional (DMG), referenciadas para o serviço especializado. Estudo transversal e descritivo em 65 gestantes portadoras de DMG, após a 20ª semana. O consumo alimentar foi quantifi cado pelo VET R24h, e pelo VET QFA, e qualifi cado pelo IQD, proposto por Fisberg et al. (2004), adaptado para a população de gestantes diabéticas. 67,7% das gestantes apresentavam IMC pré-gestacional ≥ 25 kg/m2. O valor calórico observado no R24h foi de 1657 ± 532 kcal. De acordo com o IQD, a dieta foi adequada em 51,6% das gestantes. Os componentes de pior pontuação foram os vegetais e os produtos lácteos. A ingestão de carnes, sódio e gordura total receberam as maiores pontuações. O IQD, referenciado pelo R24h e aplicado como instrumento de avaliação nutricional, evidenciou que a dieta foi considerada inadequada ou com necessidade de adequação em metade da população de gestantes avaliadas. Estas inadequações foram relacionadas à baixa ingestão de verduras e legumes e de leite e produtos lácteos. Tais resultados indicam a necessidade de priorizar ações educativas no pré-natal, para incentivar o consumo de vegetais e produtos lácteos entre essas gestantes, portadoras de DMG
To proper nutrition is important during pregnancy and especially in those complicated by diabestes. Evaluating food intake, the Indicators of Diet Quality (IDQ), in pregnant women with GDM, referenced to the specialist service. Descriptive cross-sectional study in 65 pregnant women with Gestacinal Diadetes Mellitus (GDM) after 20 weeks. Food intake was measured by R24h VET and the FFQ, and qualifi ed IDQ proposed by Fisberg et al. (2004), adapted for the population of diabetic women. 67.7% of the women had pré-pregnancy BMI ≥ 25 kg/m2 . The caloric value was observed in 24-hour recall of 1657 ± 532 kcal. According to IDQ, the diet was adequate in 51.6% of pregnant women. The components were the worst score vegetables and dairy products. The intake of meat, total fat and sodium received the highest scores. IDQ, referenced by 24-hour recall and applied as a tool for nutritional assessment showed that the diet was considered inappropriate or in need of adjustment in half of the pregnant population evaluated. These inadequacies were related to low intake of vegetables and milk and dairy products. These results indicate the need to prioritize educational activities in prenatal care, to encourage consumption of vegetables and dairy products from these pregnant women, suffering from DMG

Orientador: Iracema Matos Paranhos Calderon
Coorientador: Adriana Pederneiras Rebelo da Silva
Banca: Simone Gonçalves de Almeida
Banca: Belmiro Gonçalves Pereira
Resumo: A nutrição adequada é importante na gestação e, sobretudo, naquelas complicadas pelo diabete. Avaliar o consumo alimentar, pelo Índice de Qualidade de Dieta (IQD), em gestantes portadoras de Diabetes Melito Gestacional (DMG), referenciadas para o serviço especializado. Estudo transversal e descritivo em 65 gestantes portadoras de DMG, após a 20ª semana. O consumo alimentar foi quantifi cado pelo VET R24h, e pelo VET QFA, e qualifi cado pelo IQD, proposto por Fisberg et al. (2004), adaptado para a população de gestantes diabéticas. 67,7% das gestantes apresentavam IMC pré-gestacional ≥ 25 kg/m2. O valor calórico observado no R24h foi de 1657 ± 532 kcal. De acordo com o IQD, a dieta foi adequada em 51,6% das gestantes. Os componentes de pior pontuação foram os vegetais e os produtos lácteos. A ingestão de carnes, sódio e gordura total receberam as maiores pontuações. O IQD, referenciado pelo R24h e aplicado como instrumento de avaliação nutricional, evidenciou que a dieta foi considerada inadequada ou com necessidade de adequação em metade da população de gestantes avaliadas. Estas inadequações foram relacionadas à baixa ingestão de verduras e legumes e de leite e produtos lácteos. Tais resultados indicam a necessidade de priorizar ações educativas no pré-natal, para incentivar o consumo de vegetais e produtos lácteos entre essas gestantes, portadoras de DMG
Abstract: To proper nutrition is important during pregnancy and especially in those complicated by diabestes. Evaluating food intake, the Indicators of Diet Quality (IDQ), in pregnant women with GDM, referenced to the specialist service. Descriptive cross-sectional study in 65 pregnant women with Gestacinal Diadetes Mellitus (GDM) after 20 weeks. Food intake was measured by R24h VET and the FFQ, and qualifi ed IDQ proposed by Fisberg et al. (2004), adapted for the population of diabetic women. 67.7% of the women had pré-pregnancy BMI ≥ 25 kg/m2 . The caloric value was observed in 24-hour recall of 1657 ± 532 kcal. According to IDQ, the diet was adequate in 51.6% of pregnant women. The components were the worst score vegetables and dairy products. The intake of meat, total fat and sodium received the highest scores. IDQ, referenced by 24-hour recall and applied as a tool for nutritional assessment showed that the diet was considered inappropriate or in need of adjustment in half of the pregnant population evaluated. These inadequacies were related to low intake of vegetables and milk and dairy products. These results indicate the need to prioritize educational activities in prenatal care, to encourage consumption of vegetables and dairy products from these pregnant women, suffering from DMG
Mestre

該前瞻性研究對香港中國裔孕婦的25羥基維生素D（25（OH）D）的水平及其影響因素進行調查，并對25（OH）D與甲狀旁腺激素（PTH）、孕期肌肉酸痛、不良妊娠結局、孕期及産後骨質流失，以及嬰兒的骨骼發育等關係進行探索，力求建立適用于香港的中國孕婦的25（OH）D正常值。
共有237名單胎妊娠婦女以及62名多胎妊娠的婦女在2010年8月至2011年11月間參加本研究中的隊列研究，分別在參加研究時（<20 孕周）、24-28孕周、31-36孕周以及産後6-11周進行抽血測量血清25（OH）D以及PTH水平，同時填寫一份包括對每月攝取含維生素D的食物以及營養補充劑頻度、接受日照情況及喜好、以及肌肉不適等情況的問卷，并在24-28孕周進行75克口服葡萄糖耐量試驗。參與隊列研究的單胎孕婦在20周前、31-36孕周以及産後隨訪時接受用定量超聲測量非優勢手的橈骨遠端以及中指近掌指骨的骨質超聲速率（SoS）。在産後複查時，對其嬰兒左側腓骨中部的骨質SoS進行測量。記錄婦女各次檢查時的體重、抽血月份紫外線輻射強度的歷史記錄、以及妊娠結局。另外募集一批孕婦參加病例對照研究，比較患早產（PTB）、子癇前期（PET）、妊娠糖尿病 （GDM）以及胎兒生長受限（FGR）併發癥的婦女與對照組 （體重指數以及抽血時紫外線強度配對）的血清25（OH）D水平。
孕婦在孕期的平均25（OH）D水平在44.7 ± 12.6 至48.9 ± 17.1 nmol/l範圍，25（OH）D水平與體重指數、維生素D營養補充劑、抽血時紫外線強度以及個人對陽光的喜好情況有關，而與胎兒數量、孕次、孕周以及終止妊娠無關。
單胎妊娠的孕婦三個孕期的血清25（OH）D與PTH水平均負相關，但在多胎妊娠中，二者無明顯相關性。PTH在孕期以及産後的變化相對不受25（OH）D影響。孕婦25（OH）D的水平與孕婦肌肉酸痛癥狀、産後恢復、孕期及產褥期骨質流失以及嬰兒骨質無關。患早期PTB（< 34孕周）、PET或FGR的孕婦的血清25（OH）D比對照組低，但GDM患者的25（OH）D水平與對照組無差別。血清25（OH）D低於34.3 nmol/l者的早期早產以及子癇前期的風險增高，低於50 nmol/l者發生胎兒生長受限的風險增高。服用維生素D補充劑情況可能影響25（OH）D與FGR的關係。
總而言之，血清25（OH）D水平不足以全面完全反映孕期維生素D的情況，對預測不良妊娠結局的作用有限。
This prospective study explored the maternal serum level of 25(OH)D in Chinese pregnant women in Hong Kong and the factors affecting 25(OH)D level. It also explored the correlation between maternal 25(OH)D with PTH level, maternal musculoskeletal complaints, adverse pregnancy outcome, maternal bone turnover during pregnancy and postpartum, and the bone development of the offspring, aiming to explore and establish a normal range of 25(OH)D level in pregnancy for the Hong Kong Chinese women.
A total of 237 women with singleton pregnancy and 62 women with multiple pregnancies were recruited for the cohort study from August, 2010 to November, 2011. Maternal blood samplings for 25(OH)D and PTH measurements were performed at recruitment, 24-28 weeks, 31-36 weeks of gestation, and 6-11 weeks postpartum respectively. A questionnaire which included the monthly dietary and supplement intake of vitamin D, questions about sunlight exposure, and musculoskeletal complaints was administered on each visit. A 75g oral glucose tolerance test (OGTT) was performed on cohort cases at 24-28 weeks of gestation. Measurements of the speed of sound (SoS) at the distal one third of the maternal radius and the proximal phalanx of the third finger of the non-dominant side were performed with quantitative ultrasonography (QUS) measurement during the visits at the first and third trimesters, and postnatal period. The SoS at the left mid-shaft tibia of the offspring was determined during the postnatal visit. Maternal characteristics, ultraviolet radiation (UVR) intensity at blood sampling, and pregnancy outcome, were also recorded. Cases with pregnancy complications were recruited for case-control studies, and maternal 25(OH)D level was examined with respect to preterm birth (PTB), preeclampsia (PET), gestational diabetes (GDM), and fetal growth restriction (FGR, birthweight below the 10th percentile of the customized estimated birthweight). The controls were matched for booking body mass index (BMI) and UVR intensity at blood sampling.
The mean 25(OH)D level in ranged from 44.7 ± 12.6 to 48.9 ± 17.1 nmol/l in the three trimesters, and was related to BMI, vitamin D supplementation, UVR intensity at blood sampling, and the acceptance of sunlight exposure, but not the number of fetus, parity, gestational age, or the completion of pregnancy.
Inverse correlation between PTH and 25(OH)D were observed in singleton, but not in multiple, pregnancy. The change in maternal PTH level is found to be relatively independent from that of 25(OH)D. There was no correlation between maternal 25(OH)D level with musculoskeletal complaints, postnatal recovery, bone turnover during and after pregnancy, or the bone density of the offspring. Maternal 25(OH)D level was lower in women with early PTB ( < 34 weeks), PET, and FGR, but not for GDM. A maternal 25(OH)D level of lower than 34.3nmol/l and 50 nmol/l was associated with increased risk of early PTB, PET, and FGR respectively. But the correlation between maternal 25(OH)D level with FGR might be affected by supplementation.
In conclusion, serum level of 25(OH)D is insufficient in reflecting maternal vitamin D status and metabolism in pregnancy, and is of limited use in predicting adverse pregnancy outcome.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Hu, Zhiyang.
Thesis (Ph.D.)--Chinese University of Hong Kong, 2013.
Includes bibliographical references (leaves 201-223).
Abstracts and appendixes also in Chinese.
Thesis dedication --- p.i
Acknowledgments --- p.ii
Abstract --- p.v
Abstract (Chinese) --- p.viii
List of Abbreviation --- p.x
Table of contents --- p.xiii
List of Figures --- p.xxii
List of Tables --- p.xxiv
Chapter Chapter 1: --- Literature Review --- p.1
Chapter 1.1 --- The synthesis and metabolism of vitamin D --- p.3
Chapter 1.1.1 --- The synthesis of vitamin D --- p.3
Chapter 1.1.2 --- The metabolism of vitamin D --- p.4
Chapter 1.1.3 --- Vitamin D binding protein --- p.10
Chapter 1.1.4 --- Factors related to 25(OH)D level --- p.11
Chapter 1.2 --- Function of vitamin D --- p.13
Chapter 1.2.1 --- Mechanism of vitamin D function --- p.13
Chapter 1.2.2 --- Classic function --- p.14
Chapter 1.2.3 --- Non-classic function --- p.16
Chapter 1.2.3.1 --- Immune system --- p.17
Chapter 1.2.3.2 --- Cardiovascular system --- p.18
Chapter 1.2.3.3 --- Cell proliferation and differentiation --- p.18
Chapter 1.2.3.4 --- Neurological system --- p.19
Chapter 1.2.3.5 --- Reproductive system --- p.20
Chapter 1.2.3.6 --- Fetal development --- p.21
Chapter 1.3 --- The definition of vitamin D deficiency --- p.21
Chapter 1.4 --- Vitamin D status and pregnancy --- p.24
Chapter 1.4.1 --- Alteration in vitamin D metabolism during pregnancy --- p.24
Chapter 1.4.2 --- Factors affecting maternal serum level of 25(OH)D --- p.25
Chapter 1.4.3 --- Vitamin D and bone resorption during pregnancy and lactation --- p.27
Chapter 1.4.3.1 --- Alteration of calcium metabolism, bone absorption and the role of vitamin D --- p.27
Chapter 1.4.3.2 --- Measurement of bone density in pregnant women and babies --- p.33
Chapter 1.4.4 --- Current studies on maternal vitamin D status and pregnancy outcome --- p.35
Chapter 1.4.4.1 --- Birthweight --- p.35
Chapter 1.4.4.2 --- Infection --- p.37
Chapter 1.4.4.3 --- Preterm delivery --- p.39
Chapter 1.4.4.4 --- Diabetes (DM) and gestational diabetes (GDM) --- p.39
Chapter 1.4.4.5 --- Hypertension and preeclampsia --- p.41
Chapter 1.4.4.6 --- Multiple pregnancy, muscular symptoms --- p.42
Chapter 1.4.4.7 --- Vitamin D supplementation and pregnancy outcome --- p.44
Chapter 1.5 --- Defining vitamin D deficiency in pregnancy --- p.45
Chapter 1.6 --- Objective of the study --- p.46
Chapter Chapter 2: --- Study design and methods --- p.48
Chapter 2.1 --- Case recruitment and study design --- p.48
Chapter 2.1.1 --- Longitudinal singleton study --- p.49
Chapter 2.1.2 --- Cross-sectional study --- p.50
Chapter 2.1.2.1 --- Preterm birth (PTB) --- p.51
Chapter 2.1.2.2 --- Preeclampsia (PET) --- p.51
Chapter 2.1.2.3 --- Gestational diabetes (GDM) --- p.52
Chapter 2.1.3 --- Multiple pregnancy study --- p.52
Chapter 2.2 --- Measurements --- p.53
Chapter 2.2.1 --- Hormonal analysis of serum levels of 25(OH)D and PTH --- p.53
Chapter 2.2.2 --- Calculation of monthly intake of vitamin D from diet --- p.55
Chapter 2.2.3 --- SoS measurements --- p.56
Chapter 2.2.4 --- Ultraviolet radiation strength assessment --- p.59
Chapter 2.3 --- Statistical analysis --- p.60
Chapter Chapter 3 --- Longitudinal Study on the Level of and Factors Affecting Vitamin D in Singleton Pregnancy --- p.62
Chapter 3.1 --- Introduction --- p.62
Chapter 3.2 --- Material and method --- p.63
Chapter 3.3 --- Statistics --- p.64
Chapter 3.4 --- Results --- p.65
Chapter 3.4.1 --- Demographic data of the subjects --- p.65
Chapter 3.4.2 --- Maternal levels of 25(OH)D and PTH, and the factors affecting their levels --- p.66
Chapter 3.4.2.1 --- Distribution of 25(OH)D level and PTH level in the four visits --- p.66
Chapter 3.4.2.2 --- Dietary intake of vitamin D and supplementation --- p.69
Chapter 3.4.2.3 --- Seasonality and sunlight exposure --- p.73
Chapter 3.4.2.4 --- Parity --- p.76
Chapter 3.4.3 --- Changes of maternal levels of 25(OH)D and PTH in pregnancy --- p.78
Chapter 3.4.4 --- Independent factors related to maternal 25(OH)D level in pregnancy --- p.79
Chapter 3.4.5 --- Maternal and fetal 25(OH)D level at delivery --- p.80
Chapter 3.4.6 --- Muscular symptoms and other complaints in pregnancy, pregnancy outcome, and their relationships with maternal 25(OH)D level --- p.81
Chapter 3.4.7 --- Postnatal recovery and factors related to postnatal level of 25(OH)D and PTH --- p.86
Chapter 3.4.7.1 --- Postnatal symptoms and relationship with 25(OH)D and PTH --- p.86
Chapter 3.4.7.2 --- The postnatal level of 25(OH)D and PTH in women with different feeding mode --- p.88
Chapter 3.4.7.3 --- Independent factors related to postnatal 25(OH)D and PTH level --- p.89
Chapter 3.4.7.4 --- Factors related to the change of 25(OH)D and PTH after delivery --- p.90
Chapter 3.4.8 --- Correlation between 25(OH)D with PTH in pregnancy and postnatal period --- p.91
Chapter 3.5 --- Discussion --- p.92
Chapter 3.5.1 --- 25(OH)D level in Chinese pregnant women --- p.92
Chapter 3.5.2 --- Factors related to maternal 25(OH)D level --- p.93
Chapter 3.5.2.1 --- Dietary and supplementation --- p.93
Chapter 3.5.2.2 --- Seasonality and outdoor activity --- p.96
Chapter 3.5.2.3 --- Gestational age --- p.98
Chapter 3.5.2.4 --- Age and parity --- p.98
Chapter 3.5.3 --- Relationship of 25(OH)D level in the cord blood with maternal 25(OH)D level --- p.99
Chapter 3.5.4 --- 25(OH)D level and muscular complains in pregnancy --- p.100
Chapter 3.5.5. --- Postnatal recovery and 25(OH)D level --- p.101
Chapter 3.5.6 --- PTH level in pregnancy and postnatal period --- p.101
Chapter 3.6 --- Conclusion --- p.102
Chapter Chapter 4 --- Longitudinal Study on the Relationship between Maternal 25(OH)D level with Changes of Maternal Bone Density in Pregnancy and Lactation, and Factors Affecting Bone Density of newborn Infants --- p.105
Chapter 4.1 --- Introduction --- p.105
Chapter 4.2 --- Material and method --- p.106
Chapter 4.3 --- Statistics --- p.108
Chapter 4.4 --- Results --- p.108
Chapter 4.4.1 --- Demographic data --- p.108
Chapter 4.4.2 --- Maternal bone density and the changes in pregnancy and postnatal recovery --- p.109
Chapter 4.4.2.1 --- Maternal bone density in the first trimester and related factors --- p.109
Chapter 4.4.2.2 --- Maternal bone density in the three visits --- p.109
Chapter 4.4.2.3 --- The change in maternal bone density in the three visits --- p.110
Chapter 4.4.2.4 --- Diversity in the change of bone density in pregnant women --- p.112
Chapter 4.4.3 --- Factors related to the changes in bone density --- p.114
Chapter 4.4.3.1 --- Changes between the first and the third trimesters --- p.114
Chapter 4.4.3.2 --- Change between the third trimester and postnatal visits --- p.116
Chapter 4.4.4 --- The bone density in infants and related factors --- p.120
Chapter 4.5 --- Discussion --- p.122
Chapter 4.5.1 --- Maternal bone density changes in pregnancy and postnatal period --- p.122
Chapter 4.5.2 --- Factors related to the maternal bone density changes in pregnancy and postnatal period --- p.124
Chapter 4.5.2.1 --- Initial bone density, parity, and BMI --- p.125
Chapter 4.5.2.2 --- 25(OH)D and PTH level --- p.126
Chapter 4.5.2.3 --- Supplement --- p.127
Chapter 4.5.2.4 --- Lactation --- p.128
Chapter 4.5.2.5 --- Height --- p.129
Chapter 4.5.3 --- Factors related to bone density of the infant. --- p.130
Chapter 4.5.3.1 --- Maternal 25(OH)D level --- p.130
Chapter 4.5.3.2 --- Gestational age and birthweight --- p.131
Chapter 4.5.3.3 --- Maternal bone density change --- p.131
Chapter 4.5.3.4 --- The gender of the offspring and feeding method --- p.132
Chapter 4.6 --- Conclusion --- p.133
Chapter Chapter 5 --- Maternal 25(OH)D Level in Multiple Pregnancy --- p.134
Chapter 5.1 --- Introduction --- p.134
Chapter 5.2 --- Material and method --- p.135
Chapter 5.3 --- Statistics --- p.136
Chapter 5.4 --- Results --- p.137
Chapter 5.4.1 --- Demographic data of the subjects --- p.137
Chapter 5.4.2 --- The level of 25(OH)D in multiple pregnancy and singleton pregnancy --- p.137
Chapter 5.4.3 --- Supplementation in multiple pregnancy --- p.140
Chapter 5.4.4 --- The change of maternal 25(OH)D and PTH levels in the three trimesters --- p.141
Chapter 5.4.5 --- 25(OH)D level in cord blood and its correlation with 25(OH)D level of the sibling --- p.143
Chapter 5.4.6 --- Correlation between 25(OH) with PTH in pregnancy --- p.143
Chapter 5.5 --- Discussion --- p.144
Chapter 5.5.1 --- 25(OH)D level in multiple pregnancy and singleton pregnancy --- p.144
Chapter 5.5.2 --- Supplementation in multiple pregnancy --- p.146
Chapter 5.5.3 --- Changes of maternal levels of 25(OH)D and PTH in the three trimesters in multiple pregnancy --- p.146
Chapter 5.5.4 --- The PTH/25(OH) correlation --- p.147
Chapter 5.6 --- Conclusion --- p.148
Chapter Chapter 6 --- Maternal level of 25(OH)D in complicated pregnancy --- p.150
Chapter 6.1 --- Introduction --- p.150
Chapter 6.2 --- Method --- p.153
Chapter 6.2.1 --- Preterm birth --- p.155
Chapter 6.2.2 --- Preeclampsia --- p.155
Chapter 6.2.3 --- Gestational diabetes --- p.156
Chapter 6.2.4 --- Fetal growth restriction --- p.157
Chapter 6.2.5 --- The association between 25(OH)D level with pregnancy complication --- p.158
Chapter 6.3 --- Statistics --- p.159
Chapter 6.4 --- Results --- p.160
Chapter 6.4.1 --- Setting of the cutoff values of hypovitaminosis D --- p.160
Chapter 6.4.2 --- Preterm birth --- p.160
Chapter 6.4.3 --- Preeclampsia --- p.164
Chapter 6.4.4 --- Gestational diabetes --- p.168
Chapter 6.4.4.1 --- Case-control study --- p.168
Chapter 6.4.4.2 --- Factors affecting OGTT results --- p.170
Chapter 6.4.5 --- Fetal growth restriction --- p.173
Chapter 6.5 --- Discussion --- p.179
Chapter 6.5.1 --- Adjustment for confounders for case-control study --- p.179
Chapter 6.5.2 --- PTB and 25(OH)D level --- p.181
Chapter 6.5.3 --- PET and 25(OH)D level --- p.182
Chapter 6.5.4 --- GDM and 25(OH)D level --- p.186
Chapter 6.5.5 --- FGR and 25(OH)D level --- p.189
Chapter 6.5.6 --- Defining vitamin D deficiency in pregnancy --- p.192
Chapter 6.6 --- Conclusion --- p.195
Chapter Chapter 7 --- Summary --- p.196
References --- p.201
Chapter Appendix 1 --- Antenatal questionnaire (English/Chinese) --- p.224
Chapter Appendix 2 --- Postnatal questionnaire (English/Chinese) --- p.238

M. Tech Food Service Management (Hospitality, Tourism and Public Relations, Faculty of Human Sciences), Vaal University of Technology.
Good maternal nutrition is vital for the health and survival of the developing foetus. Nutritive inadequacy has been associated with pregnant women in developing countries particularly Sub Saharan Africa. Adequate intake of both macro and micronutrients by this vulnerable group must be ensured to avoid maternal and infant morbidity and mortality. In this study, a novel approach was employed to develop a cost effective, culturally acceptable and nutrient-dense food multi-mix (FMM) supplement that would help meet 20-25 percent of the recommended daily allowance (RDA) of pregnant women aged between 20and 30 years in the Vaal region. Twenty FMM supplements were formulated using South African food composition tables to ensure adequate nutritional content. Two out of the twenty, were selected and named FMM C1 and C3 respectively. FMM C I and C3 was selected owing to their better nutrient contents and affordability when compared with the others. Food items used to formulate FMM C 1 included maize meal, pea powder, peanut dry, milk powder and kidney beans. FMM C3 was formulated with sorghum, maize meal, peanut dry and onion powder. Chosen food items were dried, roasted, ground and mixed together proportionately. FMM supplements (C 1 & C3) were analyzed using standard laboratory techniques to determine their nutrient content. Results obtained were from the Agricultural Research Council (ARC). The shelf life of the FMM supplements was microbiologically tested. Shelf life testing proved safety for the time of consumption, as very little microbiological growth was found in 28 days. The FMM supplements were then incorporated in the development of two acceptable recipes (soup and gravy).Simple recipe leaflets were developed for use by the subjects. The process proved that it is possible to formulate a FMM or any other food product according to certain formulation criteria since formulated FMM supplements (C1 and C3) met the criteria of at least 20% RDA of Protein (g). However, the criteria for micronutrients and energy were difficult to meet as folate iron and energy showed lower percentages of 10%, 14% and 18% respectively in the experimental situation. Sensory evaluation was conducted to ascertain the acceptability of the developed recipes (soup and gravy). The sample consisted of pregnant women randomly selected from John Haynes and Sharpeville clinics respectively, it can be concluded it is possible to formulate and develop products that were culturally acceptable to the consumers (pregnant women) as sensory analysis indicated the majority (85%) of the respondents liked the gravy and 65% liked the soup. Further research is needed to address the impact on nutritional status, long-term compliance and development of range of FMM with various ingredients to determine the most nutritional, cost effective and acceptable product for pregnant women.

D. Tech. (Food Service Management, Dept. of Hospitality, Tourism and PR management), Vaal University of Technology
The main objective of this study was to develop a cost-effective, culturally acceptable, nutrient-dense food multimix (FMM) based on local food staples for pregnant women in the Vaal region. The impact of the consumption of the multimix on the nutritional status of the women, dietary diversity and outcomes of pregnancy was assessed in an intervention study by measuring the same variables as for a pilot study where the nutritional status of pregnant women was determined. Compliance was measured through monitoring of the FMM consumption and sensory evaluation tests. Quantitative food frequency questionnaires (QFFQs) and 24-hour recall questionnaires were completed in interviews. Anthropometric and biochemical measurements were recorded. The pilot study indicated that the mean total iron intake was 9,74 mg/day, below the estimated average requirement (EAR) of 22 mg/day for pregnant women. Therefore, 41,7 per cent of the women were found to be iron deficient and 50 per cent suffered from iron deficiency anaemia. Food consumed supplied little iron. Eighty per cent of the women were overweight before falling pregnant. Based on the pilot study, the FMM was developed and subjected to the following processes: chemical analysis, shelf life tests, recipe development and sensory evaluation. The product was then implemented in an intervention programme. A control group of pregnant women received soup powder. The respondents were relatively healthy and did not suffer from any chronic diseases. According to the nutrient intakes measured by the QFFQ, indicating usual dietary intakes, the iron intake of 87,5 per cent of the experimental group and 94 per cent of the control group fell below the EAR before intervention. After the intervention it improved in that the iron intake of 35,2 per cent of the experimental group and 33,3 per cent of the control group fell below the EAR. The top 10 items consumed by the experimental group during pre- and post-intervention were mainly rich in carbohydrates. Food containing iron absorption inhibitors such as tannin in tea and phytates in maize meal and bread were among the top 10 foods listed. The highest number of individual food items consumed by an individual in seven days was 39 before the intervention and 52 after the intervention, among the experimental group. The individual food variety improved after the intervention. The reason for this could be the inclusion of the FMM in their diets. The majority of the respondents consumed eight to nine of the nutritious food groups before and after the intervention. The mean food variety score (FVS) for the control group was 38,9 (±10,5) before the intervention, which decreased to 35,8 (±8,39) after the intervention. No improvement in FVS was observed after the intervention in the control group and the FVS indicated medium dietary diversity (30-60 food items). The post-intervention results show that there was an improvement in most of the iron variables. The experimental group showed statistically significant differences between pre- and post-intervention measurements in transferrin and haematocrit levels and the control group in haematocrit levels. All the babies born to the mothers of both the experimental and control groups were healthy with measurements in the normal range. The reason for this could be that the inclusion of the FMM and soup powder in the diets of the experimental and control group, respectively, made the women more aware of the importance of pregnancy monitoring. Furthermore, the attention given to the women by the clinic sisters and the researchers could have contributed to all the improvements mentioned.