Rozprawy doktorskie na temat „Pregnancy Nutritional aspects”

Thesis (MVoeding)--University of Stellenbosch, 2004.<br>ENGLISH ABSTRACT: Introduction: Heavy alcohol consumption during pregnancy is teratogenic.49-51 A woman’s nutritional requirements increase during pregnancy.4 The dangers of heavy drinking in the presence of malnutrition may put the fetus at a further disadvantage to normal development and life. Objectives: To determine the nutritional status of pregnant women in relation to alcohol consumption during pregnancy, and pregnancy outcome. To relate the combined effect of maternal alcohol consumption and nutritional status to pregnancy outcome. Study design: Prospective, longitudinal and cohort. Study population: Pregnant women attending Hanover Park MOU for pre-natal care. They were classified as subjects (heavy drinkers) or controls (light drinkers or abstainers), and 15 pairs were matched according to race, parity and gestational age at the onset of their participation in the study. Methodology: A skilled FARR worker determined the alcohol consumption of the individuals through a validated questionnaire, whilst the investigator gathered the study data blinded to the participants’ alcohol consumption status. The investigator conducted three interviews with the pregnant individuals. Anthropometrical, clinical and biochemical investigations were done and questionnaires completed to determine dietary intake, sociodemographics, health and eating habits. An experienced FARR paediatrician examined the newborns, assessing their anthropometric status, health and the presence of any alcohol-related signs. Results: The nutritional status of the matched subjects and controls did not differ significantly in terms of dietary intake, anthropometric or clinical assessment. There were significant differences between the 2 groups’ serum vitamin A values (p<0.0097). Significant associations were found between the mother and newborn data; specifically energy intake and gestational age at birth (p<0.0083), MUAC and birth weight (p<0.04), and weight gain and weight for age (p<0.0056). The participants’ energy intake also had a significant correlation with their weight gain during pregnancy (r=0.0389, p<0.01). The prevalence of FAS in the total population was 6.67%; a finding that confirms previously reported data in nearby Wellington, Western Cape.49 Conclusion: Some mothers’ good nutritional status did not protect their offspring against alcohol’s teratogenic effects. Nutritional status did have a few statistical significant effects on pregnancy. However, the investigator is of the opinion that the few significant findings were not enough to accept or reject the hypothesis; therefore, making the results inconclusive.<br>AFRIKAANSE OPSOMMING: Inleiding: Swaar alkoholgebruik tydens swangerskap is teratogenies.49-51 Vroue se voedingsbehoeftes verhoog met swangerskap.4 Die gevare van swaar alkoholgebruik in die teenwoordigheid van wanvoeding mag die fetus verhoed om normal te ontwikkel en groei. Doelwitte: Om die voedingstatus van swanger vroue te bepaal in verhouding met alkoholgebruik tydens swangerskap, en die swangerskapsuitkoms. Asook om die gekombineerde effek van die moeder se voedingstatus en alkoholgebruik op haar swangerskapsuitkoms te bepaal. Studie-ontwerp: Prospektief, longitudinaal en kohort. Studiepopulasie: Swanger vroue wat Hanover Park MOU besoek vir voorgeboorte sorg. Hulle is of as toetslinge (swaar drinkers) of as kontroles (ligte drinkers of geheelonthouers) geklassifiseer, en 15 pare is gepaar na aanleiding van ras, pariteit en gestasionele ouderdom by die aanvang van deelname aan die studie. Metodologie: ‘n Ervare SAVN lid het die individue se alkoholgebruik bepaal deur middel van ‘n gevalideerde vraelys. Die navorser was geblind vir die individue se alkoholgebruik. Die navorser het drie onderhoude gevoer met elke individu. Antropometriese, kliniese en biochemiese ondersoeke is gedoen. Vraelyste is voltooi om dieetinname, gesondheid, sosiodemografiese en eetgewoonte- inligting te versamel. ‘n Ervare SAVN pediater het alle pasgeborenes ondersoek om hulle antropometriese status, gesondheid en die teenwoordigheid van enige alkohol-verwante tekens te bepaal. Resultate: Die voedingstatus van die gepaarde toets-en kontrolegroepe het nie beduidend verskil in terme van dieetinname, antropometriese of kliniese evaluering nie. Daar was ‘n beduidende verskil tussen die 2 groepe se serum vitamien A vlakke (p<0.0097). Beduidende assosiasies is gevind tussen die moeder en pasgebore se data; naamlike tussen energie-inname en gestasionele ouderdom by geboorte (p<0.0083), bo-armomtrek en geboortegewig (p<0.0056), en gewigstoename tydens swangerskap en die baba se gewig vir ouderdom (p<0.0056). Die deelnemers se energie-inname het ook ‘n beduidende positiewe korrelasie met hul gewigstoename tydens swangerskap gehad (r=0.0389, p<0.01). Die prevalensie van FAS in die totale populasie was 6.67%; wat ook gevind is onlangs in die nabygeleë Wellington, Weskaap.49 Gevolgtrekking: Sommige moeders se goeie voedingstatus het nie hul kinders teen alkohol se teratogeniese effekte beskerm nie. Voedingstatus se effek op swangerskapsuitkoms was statisties beduidend in ‘n paar gevalle. Tog is die navorser van mening dat daar nie genoeg beduidende bewyse is om die nulhipotese te aanvaar of verwerp nie; dus is die gevolgtrekking onopgelos.

Background A well-balanced nutritious diet is important for the pregnant woman and the growing fetus, as well as for their future health. Poor nutrition results from both over-consumption of energy-rich foods which can lead to a higher weight gain than is healthy and under-nutrition of essential nutrients. Food intake is regulated in complex biological systems by many factors, where steroid hormone is one factor involved. The overall aim of this thesis is to describe dietary intake, vitamin D levels, dietary information and dietary changes, and to study the relation between allopregnanolone and weight gain during pregnancy and postpartum. Methods Study I was a qualitative study with focus group interviews with 23 pregnant women. The text was analysed with content analysis. Study II was a quantitative cross-sectional study conducted in early pregnancy (n=209) with a reference group (n=206). Self-reported dietary data from a questionnaire was analysed using descriptive comparative statistics and a cluster analysis model (Partial Least Squares modelling). Study III had a quantitative longitudinal design. Vitamin D concentrations were analysed in 184 women, collected on five occasions during pregnancy and postpartum. Descriptive comparative statistics and a linear mixed model were used. Study IV was a quantitative longitudinal study with 60 women. Concentrations of allopregnanolone were analysed in gestational week 12 and 35. Descriptive and comparative statistics as well as Spearman’s correlation (rho) were used to describe the relationship between weight gain and allopregnanolone concentrations.   Results The focus group interviews showed that women wanted to know more about different foods to reduce any risk for their child but the information about foods was partly up to themselves to find out. They expressedfeelingsof insecurityand guiltif they accidentallyate something“forbidden”. The recommendationswere followedas best as possiblealong withcommon sense todeal with dietchanges. The main themes were “Finding out by oneself”, “Getting professional advice when health problems occur”, “Being uncertain” and “Being responsible with a pinch of salt”. Some differences in the dietary patterns were found among the pregnant women compared to references, with less, vegetables (47 g/day), potatoes/rice/pasta (31 g/day), meat/fish (24 g/day) and intake of alcohol and tobacco/snuff but a higher intake of supplements. Bothpregnant women and referenceshad intakes offolatethrough diet45% (pregnant) and 22% (references) lower than current recommendations(500vs400g/day). Vitamin Dintake was34% lower than the recommendationsof 10mg/day. At least a third of the participants had insufficient plasma levels below 50 nmol/L of vitamin D. Season was a strong factor influencing the longitudinal pattern. Gestational week, season, total energy intake, dietary intake of vitamin D, and multivitamin supplementation over the previous 14 days were factors related to vitamin D levels. A correlation betweenallopregnanoloneconcentrations ingestationalweek 35and weight gainin weeks12–35was seen (p = 0.016). Therewas alsoa correlation betweenthe increase inallopregnanolone(weeks12–35) andweight gain(see above) (p = 0.028).   Conclusions Dietary recommendations were described as contradictory and confusing and the dietary advice felt inadequate. The women faced their diet changes and sought information on their own but would have wished for more extensive advice from the midwife. The intake of vitamins essential for pregnancy was lower than recommended, which is also confirmed by low plasma levels of vitamin D in at least one third of the pregnant women. Vitamin D levels peaked in late pregnancy. Aside from gestational week and season which were related to plasma levels, intake from foods and supplements also affected the levels. Reasons for weight gain are complex and depend on many factors. Allopregnanolone is a factor that was seen to relate to the weight gain of the studied pregnant women.<br>Bakgrund En välbalanserad näringsrik kost är viktig för den gravida kvinnan och det växande fostret, så även för deras framtida hälsa. En bristfällig kost kan utgöras av både överförbrukning av energirika livsmedel vilket kan leda till högre viktuppgång än vad som är hälsosamt och bristande intag av viktiga näringsämnen. Kostintag regleras av komplexa biologiska system där flera faktorer är inblandade däribland steroidhormonet allopregnanolon. Det övergripande syftet med denna avhandling är att under och efter graviditet beskriva kostintag, vitamin D-nivåer, kostinformation och kostförändringar och att studera allopregnanolons relation till viktökning. Metod Studie I var en kvalitativ studie med fokusgruppsintervjuer med 23 gravida kvinnor. Texten analyserades med innehållsanalys. Studie II var en kvantitativ tvärsnittsstudie som genomfördes i tidig graviditet (n = 209) och med en grupp icke-gravida kvinnor (kontrollgrupp) (n=206). Självrapporterade kostdata från ett frågeformulär analyserades med beskrivande, jämförande statistik och en klusteranalysmodell (Partial Least Squares modellering). Studie III hade en kvantitativ longitudinell design. Vitamin D-koncentrationer analyserades hos 184 kvinnor, vid fem tillfällen under graviditeten och efter förlossningen. Beskrivande, jämförande statistik och en linjär mixad regressionsmodell användes. Studie IV var en kvantitativ longitudinell studie med 60 kvinnor. Koncentrationerna av allopregnanolon analyserades vid graviditetsvecka 12 och 35. Beskrivande och jämförande statistik samt Spearman’s korrelation användes för att beskriva samband mellan viktökning och koncentrationer av allopregnanolon. Resultat Intervjuerna i studie I visade att kvinnor ville veta mer om olika typer av mat för att minska en eventuell risk för sina barn men kostinformation var delvis upp till dem själva att ta reda på. De VIII uttryckte känslor av osäkerhet och skuld om de råkat äta något ”förbjudet”. Rekommendationerna följdes så väl som möjligt, tillsammans med sunt förnuft för att hantera kostförändringar. Huvudteman var ”Söka information på egen hand”, ”Få professionell rådgivning när problem uppstår”, ”Känna sig osäker” och ”Ta ansvar med en nypa salt”. I studie II kunde man se vissa skillnader i kostmönster bland de gravida kvinnorna jämfört med kontrollgruppen: mindre intag av grönsaker (47 g/dag), potatis/ris/pasta (31 g/dag), kött/fisk (24 g/dag) och alkohol och tobak/snus och ett högre intag av kosttillskott. Både gravida kvinnor och kontrollgruppen hade lägre intag av folsyra via kosten med 45 % (gravida) och 22 % (kontrollgruppen) än de gällande rekommendationer som är (500 resp 400 g/dag). I studie III såg man att inta et av vitamin D var 34 % lägre än rekommendationen på 10 µg/dag. Minst en tredjedel av deltagarna hade otillräckliga plasma nivåer av vitamin D, under 50 nmol/L. Årstid var en stark faktor som påverkar det longitudinella mönstret. Graviditetsvecka, säsong, totala energiintaget, intaget av vitamin D och multivitamintillskott under de senaste 14 dagarna var faktorer som relaterade till Dvitaminnivåer. I studie IV sågs ett samband mellan allopregnanolon-koncentrationer vid graviditetsvecka 35 och viktökning från vecka 12 till 35 (p = 0,016). Det sågs också ett samband mellan ökningen av allopregnanolon (vecka 12–35) och viktökningen (se ovan) (p = 0,028). Slutsatser Kostrekommendationer beskrevs som motsägelsefulla och förvirrande och kostråden de fick uppfattades som otillräckliga. Kvinnorna tog itu med sina kostförändringar och sökte information på egen hand men hade önskat mer omfattande råd från barnmorskan. Intaget av vitaminer viktiga för graviditeten var lägre än rekommendationerna, vilket också bekräftas av låga plasmanivåer av D-vitamin hos cirka en tredjedel av de gravida kvinnorna. D-vitaminnivåerna nådde en topp i slutet av graviditeten. Graviditetsvecka och säsong på året påverkade D vitaminnivåer, så även intag via mat och kosttillskott. Orsakertill viktökning är komplexa och beror på många faktorer. Allopregnanolon är en faktor som sågs relatera till viktökningen hos de undersökta gravida kvinnorna.

Made available in DSpace on 2014-06-11T19:27:19Z (GMT). No. of bitstreams: 0 Previous issue date: 2002Bitstream added on 2014-06-13T20:35:37Z : No. of bitstreams: 1 cassettari_ml_me_botfm.pdf: 612511 bytes, checksum: 91a08595afc714e2109c38cfafc15036 (MD5)<br>A gravidez é uma fase do ciclo de vida em que a nutrição desempenha um papel muito importante, uma vez que esta influência o produto da concepção. O objetivo deste estudo foi descrever o estado nutricional de gestantes do município de Botucatu que se localiza na região centro sul do estado de São Paulo, distando aproximadamente 230km da Capital. A população é predominantemente urbana. Foram estudadas 496 gestantes com idade de 13-43 anos submetidas a entrevista para obtenção de dados socioeconômicos, demográficos e dietéticos, e coleta de sangue. Dentre as mulheres 83% eram brancas. 30,5% de adolescente, a renda mostrou que 69% estava abaixo da linha de pobreza, a escolaridade mostrou 63% era baixa, 79% casada, 25% eram fumantes, 41% eram primigestas e 12% apresentaram positividade para o exame parasitológico. As medianas para as variáveis antropométricas (percentagem de gestantes abaixo do ponto de corte) foram para: peso pré gestacional-56,0 kg;(20), peso gestacional-58,1 kg (15); estatura -158 cm(9), índice de massa corpórea pré gestacional-22,0 kg/m2 (18,7), circunferência do braço-270 mm (8,0), prega tricipital-8,6 mm (4,0).O IMC, ainda detectou 17,5% acima da normalidade. O ganho de peso semanal foi 180 g, mostrando valores maiores nas gestantes com IMC abaixo da normalidade. As medianas da ingestão de nutrientes (percentagem de gestantes que ingerem menos que 100% do RDA) foram para : energia 2186 Kcal (73), proteína 64,5 g (42), vitamina A 647,6 mg (56), a tocoferol 4,3 mg (100), vitamina C 106,0 mg (30) e ferro 11,0 mg (99). Os exames bioquímicos mostraram as medianas (percentagem abaixo do ponto de corte): hemoglobina 13,0 g/dL (3),ferro 92mg/dL (13), saturação da transferrina...<br>Pregnancy is a life cycle where nutrition plays an important role once it influences the product of conception. This study aimed to describe nutritional status of pregnant women in Botucatu located in the southern part of the State of São Paulo, 230 km far from the capital (São Paulo City). Population is predominantly an urban one. Pregnant women (496) between 13 and 43 years old were studied and subjected to interviews to obtain social, economic, demographic, dietetic data a well as blood sampling. Within the women 83% were white, 30.5% adolescents and the income showed that 69% were down poverty line, education was low 63%; 79% were married, 25% were smokers, 41% were pregnant for the first time, and 12% were positive for parasitological exam. Medians and anthropometric variables (percentage of pregnant women below cut point) were: pre-gestational weight – 56.0 kg (20) gestational weight - 58.1 kg (15) height 158 cm (9) ; pre-gestational body mass index 22.0 kg/m2 (15.o); arm circumference 270 mm (8.0); tricipital fold 18.6 mm (4.0) . BMI also detected 15.5% above normality. Weekly weight gain was 180g, with higher values on below normal BMI pregnant women. Nutrients intake medians (percentage of pregnant women who intake less than 100 % of RDA) was: energy 2186 Kcal (73), protein 64.5g (42) , vitamin A 647.mg (56), a- tocopherol 4.3 mg (100), vitamin C 106.0 mg (30) and iron 11.0 mg (99). Biochemical examinations showed medians (percentage below cut point) : hemoglobin 13.0 g/dL (3), iron 92 μ/dL (13), transferrin saturation 30.0% (8), ferritine... (Complete abstract click electronic access below)

This study was designed to measure the prevalence and nutritional impact of dairy product restriction in both pregnant and lactating women. Dairy product (DP) restriction was assessed in 2091 prenatal class attendees. Subsamples of 279 healthy pregnant and 175 exclusively breastfeeding women provided repeat 24-hour dietary recalls which were used to estimate nutrient intake and to assess dietary adequacy using adjusted nutrient distributions. Pregnancy outcome was recorded. Pregnancy. DP restriction was reported by 13.2% (95% CI: 12.7%,14.1%) of pregnant women. Significant differences were found in the proportion of restrictors (Rs, 20.8%) below the calculated EAR for adjusted protein intakes vs. nonrestrictors (NRs, 9.2%, chi 2 = 6.78, p = 0.009). Intake distributions of calcium and vitamin D were compared to their respective Als for descriptive purposes and were lower for Rs vs. NRs but dietary inadequacy could not be assessed. Infants of NRs weighed on average 120 g +/- 468.9 g more than those of Rs but this difference was not statistically significant (p = 0.06). However, in multiple regression analysis where maternal weight gain, age, education and pregravid weight were controlled for, restriction predicted a comparable loss in birthweight of 122.5 g's (p = 0.048) and vitamin D intakes were positively associated with fetal growth. Lactation. Restriction (≤250 ml milk/day) was reported by 23% (95% CI; 16%--29%) of exclusively lactating women. Protein was lower than the EAR for 60% of Rs and 37.8% of NRs (chi 2 = 6.22, p = 0.025). The proportion of Rs and NRs < EAR from diet differed for thiamin (15% vs. 0%, chi2 = 0.97, p < 0.001), riboflavin (15% vs. 1.5%, chi2 = 12.93, p < 0.001) and zinc (65.0% vs. 34.8%, chi2 = 11.6, p < 0.041). From diet and supplement intake vitamin D and calcium remained lower for Rs compared to NRs but inadequacy could not be assessed or compared. DP restriction was not associated with greater weight loss amo

This paper attempted to determine the effect that gastrointestinal discomforts, socioeconomic status, dietary knowledge and beliefs about foods to omit during pregnancy had on the nutritional status of pregnant women. Hemoglobin, upper arm muscle circumference, weight for height and eating patterns measured nutritional status. Twenty women in their second trimester of pregnancy, active duty or the dependent wife of an Air Force E-4 and below, were surveyed. Questionnaires and anthropometric measures were used. Pearson Product Moment Correlations and a canonical correlation were accomplished. Data analysis indicated a significant negative correlation between eating patterns and gastrointestinal discomfort. There was a significant positive correlation between beliefs about foods to omit and eating patterns. Significant negative correlations existed between dietary knowledge and military status, monthly grocery bill, and number of people fed.

Orientador: Sergio Alberto Rupp de Paiva<br>Resumo: A gravidez é uma fase do ciclo de vida em que a nutrição desempenha um papel muito importante, uma vez que esta influência o produto da concepção. O objetivo deste estudo foi descrever o estado nutricional de gestantes do município de Botucatu que se localiza na região centro sul do estado de São Paulo, distando aproximadamente 230km da Capital. A população é predominantemente urbana. Foram estudadas 496 gestantes com idade de 13-43 anos submetidas a entrevista para obtenção de dados socioeconômicos, demográficos e dietéticos, e coleta de sangue. Dentre as mulheres 83% eram brancas. 30,5% de adolescente, a renda mostrou que 69% estava abaixo da linha de pobreza, a escolaridade mostrou 63% era baixa, 79% casada, 25% eram fumantes, 41% eram primigestas e 12% apresentaram positividade para o exame parasitológico. As medianas para as variáveis antropométricas (percentagem de gestantes abaixo do ponto de corte) foram para: peso pré gestacional-56,0 kg;(20), peso gestacional-58,1 kg (15); estatura -158 cm(9), índice de massa corpórea pré gestacional-22,0 kg/m2 (18,7), circunferência do braço-270 mm (8,0), prega tricipital-8,6 mm (4,0).O IMC, ainda detectou 17,5% acima da normalidade. O ganho de peso semanal foi 180 g, mostrando valores maiores nas gestantes com IMC abaixo da normalidade. As medianas da ingestão de nutrientes (percentagem de gestantes que ingerem menos que 100% do RDA) foram para : energia 2186 Kcal (73), proteína 64,5 g (42), vitamina A 647,6 mg (56), a tocoferol 4,3 mg (100), vitamina C 106,0 mg (30) e ferro 11,0 mg (99). Os exames bioquímicos mostraram as medianas (percentagem abaixo do ponto de corte): hemoglobina 13,0 g/dL (3),ferro 92mg/dL (13), saturação da transferrina... (Resumo completo, clicar acesso eletrônico abaixo)<br>Abstract: Pregnancy is a life cycle where nutrition plays an important role once it influences the product of conception. This study aimed to describe nutritional status of pregnant women in Botucatu located in the southern part of the State of São Paulo, 230 km far from the capital (São Paulo City). Population is predominantly an urban one. Pregnant women (496) between 13 and 43 years old were studied and subjected to interviews to obtain social, economic, demographic, dietetic data a well as blood sampling. Within the women 83% were white, 30.5% adolescents and the income showed that 69% were down poverty line, education was low 63%; 79% were married, 25% were smokers, 41% were pregnant for the first time, and 12% were positive for parasitological exam. Medians and anthropometric variables (percentage of pregnant women below cut point) were: pre-gestational weight - 56.0 kg (20) gestational weight - 58.1 kg (15) height 158 cm (9) ; pre-gestational body mass index 22.0 kg/m2 (15.o); arm circumference 270 mm (8.0); tricipital fold 18.6 mm (4.0) . BMI also detected 15.5% above normality. Weekly weight gain was 180g, with higher values on below normal BMI pregnant women. Nutrients intake medians (percentage of pregnant women who intake less than 100 % of RDA) was: energy 2186 Kcal (73), protein 64.5g (42) , vitamin A 647.mg (56), a- tocopherol 4.3 mg (100), vitamin C 106.0 mg (30) and iron 11.0 mg (99). Biochemical examinations showed medians (percentage below cut point) : hemoglobin 13.0 g/dL (3), iron 92 μ/dL (13), transferrin saturation 30.0% (8), ferritine... (Complete abstract click electronic access below)<br>Mestre

The nutritional status of 78 women was assessed during the third trimester of pregnancy. The study was conducted in military barracks in Sierra Leone with 39 adolescent women (<20 years) and 39 adult women (>20 years).Twenty-four hour dietary recall interviews and anthropometric measures were collected. Laboratory, clinical and physiological data were obtained from the subjects' medical records. The dietary analysis of the diets consumed by adolescent and adult women showed differences in the intakes of only calcium, phosphorous, potassium, selenium and sodium. The average diet consumed by the women was <2/3 the recommended guidelines for carbohydrate and <2/3 the Recommended Dietary Allowances for persons in the U.S. for kilocalories, protein, riboflavin, pyridoxine, folacin, pantothenic acid, cholesterol, calcium, iron, magnesium, phosphorous, sodium and zinc. The women consumed diets that were >100 percent of the RDA for vitamins A, C, E, niacin and selenium. Differences occurred in the infant birthweights and Apgar scores at 1, 5 and 10 minutes between women who had abnormal measures for hemoglobin, hematocrit, ketonuria, albuminuria, glycosuria and/or malaria parasites and the women who were healthy.Maternal weight gain, age and infant health status did not correlate. The average weight gain for all the women was 17.85 kg which is within the acceptable range recommended for pregnancy. Maternal weight-at-term, gestational age, triceps skinfolds, arm circumference, hemoglobin, hematocrit were correlated with infant birthweight, length and head circumference. Maternal hemoglobin and hematocrit further correlated with infant Apgar scores at 1, 5 and 10 minutes.Hemoglobin and hematocrit levels were very low for the average women in the study (X 9.7 g/dl and 29.7 percent respectively). The malaria reduced the infant birthweight by 431 g. Albuminuria and ketonuria were associated with reduced infant birthweight while modest glycosuria was associated with increased birthweight.<br>Department of Home Economics

Dietary carbohydrate during pregnancy is essential but whether this requirement is specific to glucose or if fructose could substitute for glucose in the diet of pregnant rat dams was investigated. It was concluded that the carbohydrate requirement for the rat during pregnancy is not specific to glucose and the level, not the type, of carbohydrate was critical. The potential toxicity of high fructose diets was also investigated. Dams fed high fructose had significantly higher liver weights than dams fed high glucose while other toxic indicators were not affected. A third aspect was the comparison of isocaloric, low carbohydrate diets containing different sources of 4% glucose equivalents: glucose, fructose or lipid-glycerol. Fructose and lipid-glycerol were not adequate substitutes for glucose. The measurement of amniotic fluid glucose, which increased as either dietary glucose or fructose increased in the maternal diet may be a new, accessible nutritional indicator of carbohydrate status.

Thesis (Ph.D (Nutrition)) --University of Limpopo, 2009<br>AIM: This study aimed to assess the nutritional status of non-pregnant women of childbearing age residing in a rural area of Limpopo Province, South Africa, and the effect of fortification of staple foods on their folate and iron status. The following objectives were carried out:  To assess the socio-demographic status and maternity history of non-pregnant rural women of childbearing age.  To determine the following anthropometric measurements; body weight, height, body mass index, waist and hip circumference, and waist hip ratio of women of childbearing age.  To assess dietary intake of non-pregnant rural women of childbearing age using 24-hour recall and quantitative food frequency questionnaires prior to fortification of foods.  To determine folate status of non-pregnant rural women of childbearing age by levels of serum and red blood cell folate, and assessing vitamin B12 and homocysteine levels before and after fortification of foods.  To determine iron status of non-pregnant rural women of childbearing age by full blood count, serum ferritin, iron, total iron binding capacity, transferrin saturation and C–reactive protein before and after fortification of foods.  To determine albumin and liver enzymes (ALP, ALT, AST and GGT) of women of childbearing age before and after fortification.  To assess mycotoxins (i.e. fumonisins) in morogo samples collected randomly among participants from the study area.<br>the University of Limpopo Research Department,and the National Research Foundation

Exercise and dietary carbohydrate restriction during pregnancy independently reduce maternal weight gain and offspring survival. It was hypothesized that the combined stress of exercise and dietary carbohydrate restriction would decrease offspring survival more than the independent effects. Within the exercise and sedentary groups pregnant rats were randomly assigned to be fed either 60%, 40%, or 20% dietary carbohydrate ad libitum. No statistical interactions were found between exercise and diet. Main effects were found for litter weight, maternal feed intake and weight gain, but not for litter size, pup birthweight, or pup survival in the first two days postpartum. Exercised rats gained less weight and ate more on a per gram body weight basis than sedentary rats. Rats fed carbohydrate restricted diets ate less and gained less weight than the rats fed 60% carbohydrate. These results demonstrate that the neonatal rat is not vulnerable to the effects of moderate maternal exercise and carbohydrate restriction during pregnancy.

Since glucose is the principal substrate used during exercise and is also the main metabolic fuel for the developing embryo and fetus, exercising during pregnancy could induce a competition for fuel between fetus and exercising muscles, perturbing glucose homeostasis. To determine if exercise during pregnancy would predispose the fetus to increased risk, pregnant rats were randomly assigned to a low (4%), moderate (12%) or high (60%) carbohydrate diet, and either rested or exercised on a rodent treadmill at a moderate (15.5 m/min) or high (24.3 m/min) intensity from day 16-21 of gestation. When food intake was controlled for in the statistical model as a covariate, the level of maternal dietary carbohydrate significantly influenced maternal liver weight, heart glycogen, insulin, amniotic fluid glucose and lactate, but not maternal plasma glucose, liver or skeletal muscle glycogens. In contrast, a restricted level of maternal dietary carbohydrate, lowered fetal weight as well as fetal plasma glucose, insulin and liver glycogen. Exercise intensity significantly altered only maternal lactate levels. The results indicate that acute exercise during pregnancy can have detrimental effects on fetal development only if carbohydrate energy is restricted. Otherwise, adequate carbohydrate in the maternal diet appears to protect the fetus.

The effects of maternal dietary glucose restriction on reproductive performance were investigated by feeding pregnant rats isocaloric diets containing graded levels of dietary glucose (0, 12, 24 and 60%) during pregnancy and during pregnancy and lactation, and by measuring the effects of glucose restriction on (1) maternal, fetal and neonatal metabolism, on (2) growth and composition of the mammary glands and placentas, and (3) on milk composition. Carbohydrate restriction induced maternal metabolic adaptations that were proportional to the severity of the glucose restriction. Placental growth and composition as well as mammary gland composition were not affected by dietary glucose restriction, whereas fetal growth and development and milk composition were significantly impaired when glucose was limited in the maternal diet. This suggests that the effects of dietary glucose on the fetus and on milk composition were not mediated by changes in placenta and mammary gland DNA, protein or glycogen concentrations. Complete dietary glucose restriction significantly depressed fetal liver, lung and heart glycogen concentrations; repletion of the maternal diets with 12 and 24% glucose restored cardiac glycogen to normal but not fetal lung glycogen and liver glycogen. Pups born to dams fed a glucose-free diet failed to survive longer than 24 h postpartum and that was associated with the low levels of tissue glycogen at birth in these pups. At birth, lung and liver glycogen concentration of pups of the 12 and 24% glucose diets was similar to pups of the control diet despite the fact that these reserves were depressed in utero; and these pups efficiently corrected the transient hypoglycemia observed following parturition. The effects of glucose restriction on fetal liver glycogen were not reflected by similar changes in fetal plasma insulin, glucagon and glucose levels or in glycogen synthase and phosphorylase activities. Maternal dietary glucose was an important determinant

Weight, height, skinfold thicknesses, circumference measurements, and 72-hour food records were collected from pregnant women (N=51) at four-week intervals between the 12th and 40th weeks of gestation. Subjects were divided Into two groups according to percent standard prepregnant weight for height: overweight > 110% (N=17) and normal weight < 110% (N=28). Changes In weight, skinfold thicknesses and circumference measurements were similar between the two groups during the third trimester (weeks 28 to 40 of gestation). Significant increases in weight (1.58 kg per four weeks) and waist circumference and significant decreases in calf and abdominal skinfold thicknesses are reported. When the second and third trimesters (weeks 12 to 40 of gestation) were considered mean weight gain was 1 .87 kg per four-week interval. Overweight gravidas demonstrated a significantly greater decrease in abdominal skinfold thickness than normal-weight gravidas. The patterns of change over the second and third trimesters were different between the two groups for abdominal, knee, and calf skinfold thickness, hips and thigh circumference, body fat, and percent body fat. Caloric and macronutrient consumption was similar between groups and did not change throughout the second the two and third trimesters. Maternal weight gain was significantly associated with infant birth weight in both groups.<br>M.S.

Background Excessive gestational weight gain (GWG) poses significant risk for maternal and neonatal health. Various guidelines have recommended healthy diets and enhancing physical activity during pregnancy to prevent excessive GWG. However, results of intervention studies are inconsistent in the developed countries, and there are no official guidelines and few interventions for GWG in China. This paper aims to review and synthesize relevant studies on diet and physical activity interventions to prevent excessive GWG so that practical suggestions can be provided to public health authorities in China. Methods This systematic review was performed using PubMed, Google and Google Scholar to search all relevant studies in English and randomised controlled trials (RCTs) that investigated diet and physical activity interventions to limit excessive GWG up to May 2014. The quality of included studies was assessed using CONSORT statement and JADAD scale. Results Nine studies describing diet and physical activity interventions to prevent excessive GWG were incorporated in the systematic review. Overall, the contents of interventions were diverse, which consisted of one-to-one counselling, and community-based physical activity interventions. Weekly mailed newsletters and supportive telephone calls were used as assistive tools to remind pregnant women of limiting excessive GWG. Seven studies showed less weight gain in pregnant women receiving the intervention, of which four studies demonstrated a reduction in excessive GWG in women with varying body mass index (BMI) spanning the normal, overweight and obese categories, while three studies reported a reduction of excessive GWG only in normal weight women and obese women need to be paid attention in the future. Conclusions The effectiveness of diet and physical interventions to limit excessive GWG may not be confirmed because of limited quality or sample size of intervention studies. However, studies have demonstrated reduction of excessive GWG during pregnancy, in addition to persistent healthy behaviours following such interventions during pregnancy. Further meta-analyses of RCTs studies should be done to confirm the effectiveness of such interventions among Chinese women.<br>published_or_final_version<br>Public Health<br>Master<br>Master of Public Health

The effect of maternal dietary glucose on perinatal phosphoenolpyruvate carboxykinase (PEPCK) gene expression was investigated in this study. Pregnant rats were fed isoclaoric diets containing graded levels of glucose (0%, 12%, 24% and 60%) from gestation day 2 to lactation day 15. The developmental profiles of PEPCK gene expression in fetal and neonatal liver and kidney were analyzed by northern blot. In the liver, feeding glucose free and glucose restriction (12% and 24%) diets precociously induced PEPCK gene expression at day 21 of gestation. In the kidney, PEPCK mRNA (2.8 kb) was detected at birth in the glucose free group, 12-16 hours postnatally in control group; it was not visualized until day 3 in the 12% and 24% glucose restriction groups. In our study, two species of RNA (1.8 kb and 2.8 kb) were hybridized with PEPCK cDNA probes, and there was a relationship between maternal dietary glucose levels and the 1.8 kb RNA fragment in the kidney.

The interrelation among maternal dietary intake, pregravid weight, amount and pattern of gestational weight gain and cigarette smoking in influencing the balance between fetal growth and maternal postpartum weight retention was in investigated in 1,330 healthy participants in the PEI Nutritional Counselling Program. Among nonsmokers, gestational weight gain was the main predictor of postpartum weight retention and explained 65.3% of its variability, while explaining only 4.7% of infant birth weight variability. Women with higher postpartum weight retention gained more weight during pregnancy and most of the difference between higher and lower weight retention groups occurred in the first 20 weeks. When comparing infant size between smoking and nonsmoking mothers, birth weight increased linearly with maternal weight gain in all weight status groups except in overweight nonsmokers where birth weight reached a plateau at weight gains $>$17 kg. Among smokers, infant length increased at a higher rate with weight gain than nonsmokers. Although higher weight gains seemed to partially mitigate the effect of smoking on the risk of small-for-gestational-age (SGA) infants, such risk remained $>$10% at elevated weight gains among underweight smokers. The effects of smoking in reducing maternal and infant weights were not mediated by lower energy intake, as smokers consumed more energy than nonsmokers after controlling for physical activity and pregravid weight. The independent relative risks of SGA infants due to maternal smoking, pregravid underweight and low weight gain, were 3.23, 1.80 and 1.72 respectively, implying that smoking has the greatest effect on SGA. Based on current smoking prevalence in Canada, the population etiologic fraction of SGA due to the direct effect of smoking is 30.8%; approximately twice that for maternal underweight or low weight gain. Efforts to increase infant birth weight through higher maternal weight gain would require impractically high ene

Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--University of Stellenbosch, 2010.<br>ENGLISH ABSTRACT: Introduction : The health status of women in peri-urban areas has been influence by the South African political transition. Despite some progress, maternal and child mortality rates are still unacceptably high. A mother’s nutritional status is one of the most important determinants of maternal and birth outcomes. The Institute of Medicine’s pre-pregnancy Body Mass Index (BMI) method is not always appropriate to use in a peri-urban setting as many women attend their first antenatal clinic later on in their pregnancy. Two alternative methods, the gestational BMI (GBMI) and the gestational risk score (GRS), have been used elsewhere to screen for at risk pregnancies, but have not been used in a South African peri-urban setting. Furthermore, examining socio-economic variables (SEV) aids in the explanation of the impact of social structures on an individual. Risk factors can then be established and pregnant women in these higher risk groups can be identified and given additional antenatal clinic appointments and priority during labour. Aim: The first aim was to investigate the strength of the GBMI and GRS methods for predicting birth outcomes and maternal morbidities. The second aim was to investigate the relationships between SEV, GBMI and maternal morbidities. Methods: This was a sub-study of the Philani Mentor Mothers Study. A sample of 103 and 205 were selected for investigating the prediction methods and SEV respectively. Maternal anthropometry, gestational weeks and SEV were obtained during interviews before birth. Information obtained was used to calculate GBMI and GRS and to assess the SEV. Birth outcomes were obtained from the infant’s clinic cards and maternal morbidities were obtained from interviews two days after the birth. Results No significant association was found between GBMI and birth outcomes and maternal morbidities. A significant positive association was found between GRS and birth head circumference percentile (r=0.22, p<0.05). The higher the GRS, the higher the risk of an infant spending longer time in the hospital (Kruskal Wallis X2 = 4, p<0.05). A significant positive association was found between GBMI and the following SEV factors; age (r=0.33, p<0.05), height (r=0.15, p<0.05), parity (r=0.23, p<0.05), income (r=0.2, p<0.05), marital status (X2 = 9.35, p<0.05), employment (U=2.9, p<0.05) and HIV status (U=2.54, p<0.05). No statistically significant relationships were found between gestational hypertension and gestational diabetes mellitus and SEV. Conclusion: From the findings of this sub-study there were some promising results, however it is still unclear as to which method is the most appropriate to predict adverse birth outcomes and maternal morbidity. It is recommended that the GBMI and GRS once-off methods be repeated in a larger population to see if there are more parameters that could be predicted. Women who were older, shorter, married, had more pregnancies, HIV negative and had a higher socioeconomic status tended to have a greater GBMI. This can lead to adverse birth outcomes and increases the risk of women developing maternal morbidities and other chronic diseases later in their life. Optimal nutrition and health promotion strategies targeting women before conception should be implemented.<br>AFRIKAANSE OPSOMMING: Inleiding: Die gesondheidstatus van vroue in semi-stedelike areas is beïnvloed deur die Suid-Afrikaanse politiese oorgang. Ten spyte van ’n mate van vooruitgang is die sterftesyfers vir moeders en kinders steeds onaanvaarbaar hoog. ‘n Moeder se voedingstatus is een van die mees belangrike bepalende faktore van moeder- en geboorteuitkomste. Die Instituut van Geneeskunde se voorswangerskap Liggaamsmassa Indeks (LMI) metode is nie altyd toepaslik om te gebruik in ‘n semi-stedelike opset nie aangesien baie vroue hul eerste voorgeboorte-kliniek eers later in hul swangerskap bywoon. Twee alternatiewe metodes, die swangerskap LMI (SLMI) en die swangerskap risiko telling (SRT) is al elders gebruik as sifting vir hoë risiko swangerskappe, maar is nog nie gebruik in ‘n Suid-Afrikaanse semi-stedelike opset nie. Vervolgens kan ‘n ondersoek na sosio-ekonomiese veranderlikes (SEV) help om die impak van maatskaplike strukture op ‘n individu te verduidelik. Risiko faktore kan dan vasgestel word en swanger vroue wat in hierdie hoër risiko groepe val kan geïdentifiseer word. Dié vroue kan addisionele voorgeboorte-kliniek afsprake ontvang asook voorkeurbehandeling tydens die geboorteproses. Doelstellings: Die eerste doelstelling was om die sterkte van die SLMI en SRT metodes te ondersoek as voorspellers van geboorte uitkomste en moeder-morbiditeite. Die tweede doelstelling was om die verhoudings tussen SEV, SLMI en moeder-morbiditeite te ondersoek. Metodes: Hierdie projek was ‘n sub-studie van die Philani Mentor Moeders Studie. ‘n Steekproefgrootte van 103 en 205 was geselekteer om onderskeidelik die voorspeller metodes en SEV te ondersoek. Die moeder se antropometrie, swangerskap weke en SEV was verkry gedurende onderhoude voor geboorte. Informasie ingewin was gebruik om die SLMI en SRT te bereken en om die SEV te ondersoek. Geboorteuitkomste was verkry vanaf die babas se kliniekkaarte en moeder-morbiditeite was verkry tydens onderhoude twee dae na die geboorte. Resultate: Geen betekenisvolle assosiasie was gevind tussen SLMI, geboorteuitkomste en moeder-morbiditeite nie. ‘n Betekenisvolle positiewe assosiasie was gevind tussen SRT en die geboorte kopomtrek persentiel (r=0.22, p<0.05). Hoe hoër die SRT, hoe hoër die risiko dat ‘n baba langer in die hospitaal sou bly (Kruskal Wallis X2=4, p<0.05). ‘n Betekenisvolle positiewe assosiasie was gevind tussen SLMI en die volgende SEV faktore: ouderdom (r=0.33, p<0.05), lengte (r=0.15, p<0.05), pariteit (r=0.23, p<0.05), inkomste (r=0.2, p<0.05), huwelikstatus (X2=9.35, p<0.05), besit van ‘n identiteitsdokument (U=1.75, p<0.05), werkstatus (U=2.9, p<0.05) en MIV status (U=2.54, p<0.05). Geen statisties beduidende verhoudings was gevind tussen swangerskap hipertensie, swangerskap diabetes mellitus en SEV nie. Gevolgtrekking Sommige bevindinge van hierdie sub-studie dui op belowende resultate, alhoewel dit steeds nie duidelik is watter metode die mees toepaslike is om ongewenste geboorteuitkomste en moeder-morbiditeit te voorspel nie. Dit word aanbeveel dat die SLMI en SRT eenmalige metodes herhaal word in ‘n groter populasie om te sien of daar meer parameters is wat voorspel kan word. Vroue wat ouer, korter, getroud, meer swangerskappe, MIV negatief en ‘n hoër sosio-ekonomiese status gehad het was geneig om ‘n hoër SLMI te hê. Dit kan lei tot ongewenste geboorteuitkomste en verhoogde risiko om moeder-morbiditeite en ander chroniese siektes later in hul lewe te ontwikkel. Optimale voeding en gesondheidsbevordering strategieë wat vroue teiken voor bevrugting behoort geïmplementeer te word.

Thesis (MNutrition )ITE))--Stellenbosch University, 2012.<br>ENGLISH ABSTRACT: Introduction: The primary objective was to determine whether pregnant women visiting primary health care clinics (PHCs) were aware of the nutritional supplementation programmes: Nutrition Supplementation Programme (NSP) food, folate-, iron- and vitamin A supplementation. The secondary objective was to determine whether pregnant women qualified for the NSP food-, folate- and iron supplementation. The third objective was to determine whether those who qualified received the prescribed NSP food-, folate-, and iron supplementation and whether they were compliant with these interventions. Design: A cross-sectional descriptive study was conducted at all PHCs hosting basic antenatal clinics in the Cape Town Metropolitan Area of the Western Cape Province, South Africa. Method: One hundred and fourteen pregnant women who met the inclusion criteria were included in the study using a non-random quota sampling strategy. Pregnant women were interviewed using a validated questionnaire. The mid upper arm circumference (MUAC) was measured and the symphysis-fundus (SF) measurement was obtained from the medical files to determine whether participants met the entry criteria for the NSP. Written informed consent was obtained from participants. Results: Fifty per cent of participants were between 12 and 24 weeks of gestation. Most of them (68%) had an MUAC of between 24,7 cm and 34,4 cm. Fifty (44%) of the participants had a sufficient SF measurement. Twenty-one (18%) of the participants indicated that they were aware of the vitamin A Programme, 56 (49%) were aware of the NSP food-supplementation and 79 (70%) knew about the folicand iron supplementation that pregnant women should receive from the clinic. Six (5%) participants qualified for the NSP with an MUAC of below 23 cm. Only one (17%) participant was registered with the NSP and received the food-supplementation. Seventy (61%) of the participants indicated that they received and used the iron- and folic supplements, of which 30 (43%) did not know why they needed to take these supplements. Conclusion: Folate- and iron supplementation appears to be reasonably successfully implemented in the Cape Town Metropolitan Area among pregnant women visiting PHCs. The NSP food-supplementation, however, appears to be unsuccessfully implemented and needs further attention. Resources could be appointed to inform pregnant women about the reasons for and importance of taking these supplements.<br>AFRIKAANSE OPSOMMING: Inleiding: Die hoofdoelstelling was om te bepaal of swanger vroue wat primêre gesondheidsorgklinieke (PGK’s) bywoon, bewus was van die voeding supplementasie programme: Voedsel Supplementasie Program (VSP) – voedselaanvulling, folaat-, yster- en vitamien A supplementasie. Die tweede doelstelling was om te bepaal of hierdie swanger vroue in aanmerking kom vir die VSP– voedselaanvulling, folaat- en yster supplementasie. Die derde doelstelling was om te bepaal of hierdie swanger vroue die voorgeskrewe VSP – voedselaanvulling, folaat- en yster supplementasie ontvang het en hierdie intervensies nagevolg het. Ontwerp: ʼn Deursnit beskrywende studie is gedoen en data is ingesamel van al die PGK’s wat voorgeboortelike klinieke huisves in die Kaapstadse metropolitaanse gebied, in die Wes-Kaapprovinsie, Suid-Afrika. Metode: Honderd en veertien swanger vroue wat aan die insluitingskriteria voldoen het, is volgens ʼn nie-ewekansige kwotastrategie uitgesoek om aan die studie deel te neem. Onderhoude is volgens ʼn bevestigde vraelys met swanger vroue gevoer. Die omtrek van die middelboarm is geneem en die symphysis-fundus-meting is van die mediese lêers verkry om te bepaal of deelnemers aan die insluitingskriteria vir die VSP voldoen. Deelnemers het ʼn vrywaringsvorm geteken voordat hulle aan die studie begin deelneem het. Resultate: Vyftig persent van die swanger vroue het ʼn gestasie-ouderdom van tussen 12 en 24 weke gehad. Die omtrek van die meeste vroue (68%) se middelboarm was tussen 24,7 cm en 34,4 cm. Vyftig (44%) van die vroue se symphysis-fundusmeting was voldoende. Een en twintig (18%) van die deelnemers het aangedui dat hulle van die Vitamien A-program bewus was, 56 (49%) was van die VSPvoedselaanvulling bewus en 79 (70%) van die deelnemers was bewus van die folaat- en yster supplementasie wat swanger vroue van die kliniek behoort te ontvang. Ses (5%) deelnemers, met ʼn middelboarm-omtrek van minder as 23 cm, het vir die VSP in aanmerking gekom. Slegs een (17%) deelnemer was geregistreer en het die voedselaanvulling ontvang. Sewentig (61%) van die deelnemers het aangedui dat hul wel yster- en folaat supplementasie ontvang en gebruik, waarvan 30 (43%) nie geweet het waarom hulle dié supplemente neem nie. Gevolgtrekking: Dit wil voorkom asof folaat- en yster supplementasie vir swanger vroue wat PGK’s in die Kaapstadse metropolitaanse gebied besoek, redelik suksesvol toegepas word. Daarteenoor word die VSP – voedselaanvulling onsuksesvol uitgevoer en behoort dit verdere aandag te geniet. Hulpbronne kan aangewys word om swanger vroue beter in te lig oor die doel en belangrikheid daarvan om hierdie supplemente te neem.

The nutritional food situation in our country is alarming, by what has been classified as a major public health problem, their principle manifestation is the protein malnutrition- energy, with a high prevalence in urban zones- marginal and rural population. It is considered that the main causes that originate on one hand are still deteriorating at a level of income in the popular sectors with the consequent impossibility of access to basic services such as housing, education, stable jobs, health services (drinking water, sewage, etc.) appropriate food regimes, greatly affecting those vulnerable groups such as children and women in fertile years. (1) The nutritional problem is so bad where a major part of the pregnant women in the country live, that they compromise not only their physiological conditions but what is even more serious, the irreversible attention to uterine development of children, causing degeneration in growth and development. (2) (3) Around a half a million women in the world die annually due to complications related with pregnancy and delivery, 99 percent of these deaths coming from countries in development. Women of said countries have a greater number of pregnancies and reduced access to adequate medical services in developing countries. A good number of maternal deaths could be prevented through routine prenatal and obstetric services. (4) As such in 1998 at a national level they determined that 60% of pregnant women died from anemia due to the lack of iron, 30-40% suffered from some type of malnutrition and 30% of Ecuadorian women had children without previous assistance. (5) According to CEPAR, in Ecuador the reason for maternal mortality estimated by ENDEMAIN -94 during the period of 1988-1994, was 160 maternal deaths per 1000 live births for women between the ages of 15-49; this means that approximately 460 women die each year due to causes of pregnancy, childbirth or postpartum. (6) Moreover, our country is generating a social process - organized to strengthen the farming organization and to seek alternatives that address this serious situation and, upon further analysis of these causes, more concerns and realities are born that require special attention such as the women situation, whose role is fulfilled within the family and community. (19) Due to the migration of man to different workplaces in search of a better life for the family, the indigenous woman faces the responsibility of double shifts that link the poverty condition and neglect of members of the family, causing serious nutritional disorders. Faced with this situation, the Faculty of Nutrition and Health Education, in agreement with the Benson institute, has started a study on feeding behavior and health of indigenous women during the period of pregnancy, with the purpose of contributing to the change of their way of life and thus avoid possible risk factors.

Height, skinfold, and circumference measurements were obtained from 29 normal weight and 17 overweight (>110% of desirable weight for height) healthy pregnant women every four weeks during their second trimester of pregnancy. The mean weight gain and food intake values were not significantly different for both groups. Measurements increased at a greater rate for the normal weight gravidas than for the overweight gravidas in almost every case. For both groups, increases in fat stores were greater in the central sites than in the peripheral sites. No clear relationship between age, prepregnant weight, and weight gain during the second trimester with the birthweight of the baby was found. The infant birthweights of both groups were at an optimal level ( >2500 grams) except for one (born to the mother 151% of her desirable weight for height). The similarity in results for the two groups is greatly due to there not being a large enough difference in prepregnant weights between the two groups. Nevertheless, the results do lend support to a 20 to 30 pound weight gain for an optimal outcome of pregnancy for healthy pregnant women with a wide range of prepregnancy weights. Those women 150% or more of their desirable weight for height may need to gain on the lower end of the spectrum due to their excess endogenous reserves and to possible harm to the fetus with large gains.<br>Master of Science

Thesis (Mnutr)--University of Stellenbosch, 2003.<br>ENGLISH ABSTRACT: Pregnancy and growth have been found to have a detrimental effect on the micronutrient status of adolescent girls. Dietary studies in adolescents have shown serious shortfalls in their dietary iron and folate intake. The competition for nutrients between the fetus and a pregnant adolescent may carry the risk of complications such as intrauterine growth retardation, pre-eclampsia, both maternal and fetal intrapartum mortality, the increased risk of birth injuries and low birth weight. The aim of the study was to assess the nutritional status of rural black, pregnant teenagers attending the antenatal clinic at Siloam Hospital in the Limpopo Province, with special emphasis on iron and folic acid intake, and evaluation of the newborn babies in terms of weight status and neural tube defects. The nutritional status was determined in 40 pregnant and 40 non-pregnant adolescent girls. The pregnant girls were selected during their first visit to the antenatal clinic, and the non-pregnant girls were selected from nearby schools. The demographic and dietary history questionnaires were used to collect information from the subjects. The dietary intake of the subjects was collected by the completion of a pre-tested quantified food frequency questionnaire. The anthropometric questionnaire was used to get information from the pregnant adolescents and the control group. The infant anthropometric measurements questionnaire provided information on the infant and the outcome of birth. Blood was collected from the pregnant adolescent girls and the control subjects. Anaemia was observed in 57.5% of the pregnant and 27.5% of the non-pregnant adolescents (haemoglobin <Il g/dl and <12 g/dl, respectively). The prevalence of low serum ferritin « 12 ug/L) and low transferrin saturation « 16%) was high in both the pregnant (30% and 60% respectively) and the non-pregnant adolescents (17% and 72.5% respectively). Iron deficiency was observed in 45% of the pregnant girls and 35% of the control subjects. The prevalence of iron deficiency anaemia in the pregnant girls (30%) and the control subjects (22.5%) was high. Low red blood cell folate in pregnant and non-pregnant girls was uncommon. Low serum vitamin BI2 was common in most of the pregnant girls. Analysis of the quantitative food frequency questionnaire (QFFQ) that was completed for 80 of the pregnant and non-pregnant girls showed that 55% had low dietary iron intakes «67% of the RDA) (p = 0.7307). Forty-five percent of the pregnant girls reported taking iron supplements. The QFFQ showed 20% of pregnant girls with low intake of folate (p = 0.0577). Forty-five percent of pregnant girls also reported taking folate supplements. Anthropometric measurements of pregnant girls and their dietary intake could not be correlated to the birth outcome. The social profile of the subjects did not seem to influence their iron and folate status and the outcome of pregnancy. The findings in this study showed that pregnant adolescents appeared to be similar to the non-pregnant adolescent girls socio-economically, anthropometric and nutritionally. We recommend that educational programmes targeted at adolescents and teenagers in the Siloam area should reach girls that could potentially fall pregnant. An educational programme must include: reproductive needs (avoidance of sex or safe sex); nutritional needs, especially targeted at improving nutritional status to meet future reproductive needs; early booking at the antenatal clinic and effective supplementation during pregnancy. The need to improve the dietary and nutrient intake of the adolescent girls should be addressed within the current framework of the Integrated Nutrition Programme (!NP). A food fortification programme with essential micronutrients such as iron, folic acid, zinc and Vitamin A to improve the micronutrient status should be promoted among the adolescent girls.<br>AFRIKAANSE OPSOMMING: Daar is bevind dat swangerskap en groei 'n nadelige effek het op die mikronutriëntstatus van vroulike adolessente. Dieetstudies in adolessente het ernstige tekortkominge in dieetyster- en folaatinnames getoon. Die kompetisie vir nutriente tussen die fetus en die swanger adolessent kan verantwoordelik wees vir komplikasies soos intra-uterine groeivertraging, preeklampsie, verhoogde mortaliteit van beide moeder en baba tydens kraam, 'n verhoogde risiko vir geboortebeserings en lae geboortegewig. Die doel van die studie was om die effek van voedingstatus by swart, swanger tieners by die voorgeboortekliniek in Siloam Hospital in die Limpopo-provinsie te bepaal, met spesifieke verwysing na die yster- en foliensuurinname, asook die evaluering van die pasgebore babas in terme van gewig en neurale buis defekte. Die voedingstatus van 40 swanger en 40 nie-swanger adolessente meisies IS bepaal. Die swanger meisies is ewekansig geselekteer gedurende die eerste besoek aan die voorgeboortekliniek , en die nie-swanger meisies is geselekteer by nabygeleë skole. Die demografiese en dieetgeskiedenisvraelyste is gebruik om inligting van die proefpersone in te samel. Voorafgetoetste gekwantifiseerde voedselfrekwensie vraelyste is gebruik om die voedselinname van proefpersone te bepaal. Antropometriese vraelyste is gebruik om antropometriese inligting van die swanger adolessente en die kontrole groep. Die antropometriese vraelys vir babas is gebruik om inligting ten opsigte van die baba aan te teken asook die verloop van die swangerskap. Bloedmonsters is van die swanger tieners en die kontrole groep ingesamel. Anemie is waargeneem by 57.5% van die swanger en 27.5% van die nie-swanger adolessente (hemoglobien <Il g/dl en <12 g/dl onderskeidelik). Die voorkoms van lae serum ferritien « 12 ugIL) en lae transferrienversadiging « 16%) was hoog by beide die swanger (30% en 60%) en die nie-swanger adolessente (17.5% en 72.5% onderskeidelik). Ystergebrek is in 45% van die swanger meisies en in 35% van die kontrole groep waargeneem. Die voorkoms van ystergebrekanemie in die swanger meisies (30%) en die kontrole groep (22.5%) was hoog. Lae rooibloedselfolaat by swanger en nie-swanger meisies is nie algemeen waargeneem nie. Lae serum vitamien B12 was algemeen by die meeste swanger meisies. Ontleding van die gekwantifiseerde voedselfrekwensievraelys (KVFV) wat vir 80 van die swanger en nie-swanger meisies voltooi is, het getoon dat 55% 'n lae dieetysterinname gehad het «67% van die ADT) (p=0.7307). Vyf-en- veertig persent van die swanger meisies het bevestig dat hulle ystersupplemente gebruik het. Die gekwantifiseerde voedselfrekwensievraelys (KVFV) het getoon dat 20% van die swanger meisies 'n lae folaatinname het (0.0577). Vyf-en-veertig persent van die swanger meisies het ook genoem dat hulle folaatsupplemente gebruik het. Die antropometriese metings van swanger meisies en dieetinname kon nie gekorreleer word met die verloop van die geboorte nie. Dit blyk dat die sosiale profiel van die meisies nie 'n effek op die yster- en folaatstatus en op die verloop van swangerskap gehad het nie. Die bevindinge van hierdie studie toon dat swanger en nie-swanger adolessente meisies sosio-ekonomies, antropometries en nutrisioneel dieselfde voorkom. Dit word aanbeveel dat voorligtingsprogramme vir adolessente en tieners in die Siloam-area meisies moet bereik wat moontlik swanger sal word. 'n Voorligtingprogram moet die volgende insluit: reproduktiewe behoeftes (vermyding van seks of veilige seks); voedingbehoeftes, veral geteiken om voedingstatus te verbeter om ten einde toekomstige voorplantingsbehoeftes te vervul; vroeë besoeke aan die voorgeboortekliniek en effektiewe supplementering gedurende swangerskap. Die behoefte om die dieet en nutriëntinname van adolessente meisies te verbeter moet binne die huidige raamwerk van die Geintegreerde Voedingsprogram aangespreek word. 'n Voedselfortfiseringsprogram met essensiële mikronutriënte soos yster, foliensuur, sink en vitamien A om die mikronutriëntstatus van adolessente meisies te verbeter, moet bevorder word.

Made available in DSpace on 2016-06-07T17:12:00Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-01-22. Added 1 bitstream(s) on 2016-06-07T17:16:33Z : No. of bitstreams: 1 000864313.pdf: 5847541 bytes, checksum: 79d376f36de687b2301fef412b63caed (MD5)<br>Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)<br>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...<br>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<br>Coorientador: Maria Helena D'Aquino Benício<br>Banca: Daniela Saes Sartorelli<br>Banca: Luiza Cristina Godim Domingues Dias<br>Banca: Paula Andrea Martins<br>Banca: Silvia Justina Papini<br>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...<br>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 ...<br>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.<br>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.

<p>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.</p>

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.<br>Department of Family and Consumer Sciences

Thesis (MNutr)--Stellenbosch University, 2012.<br>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.<br>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<br>Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Biologia<br>Made available in DSpace on 2018-08-12T11:27:11Z (GMT). No. of bitstreams: 1 Cruz_BreadLeandroGomesda_M.pdf: 401647 bytes, checksum: bd87e2b677303756744ab1ef75ad2316 (MD5) Previous issue date: 2007<br>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.<br>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.<br>Mestrado<br>Fisiologia<br>Mestre em Biologia Funcional e Molecular

Made available in DSpace on 2014-06-11T19:29:52Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-08-25Bitstream added on 2014-06-13T21:00:21Z : No. of bitstreams: 1 reis_lbsm_me_botfm.pdf: 333414 bytes, checksum: 00632c68d72a8c1007b949353edca497 (MD5)<br>Fundação de Ensino e Pesquisa em Ciências da Saúde (FEPECS)<br>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<br>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<br>Coorientador: Adriana Pederneiras Rebelo da Silva<br>Banca: Simone Gonçalves de Almeida<br>Banca: Belmiro Gonçalves Pereira<br>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<br>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<br>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。<br>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。<br>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。<br>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。<br>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。<br>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.<br>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.<br>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.<br>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.<br>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.<br>Detailed summary in vernacular field only.<br>Detailed summary in vernacular field only.<br>Detailed summary in vernacular field only.<br>Detailed summary in vernacular field only.<br>Detailed summary in vernacular field only.<br>Hu, Zhiyang.<br>Thesis (Ph.D.)--Chinese University of Hong Kong, 2013.<br>Includes bibliographical references (leaves 201-223).<br>Abstracts and appendixes also in Chinese.<br>Thesis dedication --- p.i<br>Acknowledgments --- p.ii<br>Abstract --- p.v<br>Abstract (Chinese) --- p.viii<br>List of Abbreviation --- p.x<br>Table of contents --- p.xiii<br>List of Figures --- p.xxii<br>List of Tables --- p.xxiv<br>Chapter Chapter 1: --- Literature Review --- p.1<br>Chapter 1.1 --- The synthesis and metabolism of vitamin D --- p.3<br>Chapter 1.1.1 --- The synthesis of vitamin D --- p.3<br>Chapter 1.1.2 --- The metabolism of vitamin D --- p.4<br>Chapter 1.1.3 --- Vitamin D binding protein --- p.10<br>Chapter 1.1.4 --- Factors related to 25(OH)D level --- p.11<br>Chapter 1.2 --- Function of vitamin D --- p.13<br>Chapter 1.2.1 --- Mechanism of vitamin D function --- p.13<br>Chapter 1.2.2 --- Classic function --- p.14<br>Chapter 1.2.3 --- Non-classic function --- p.16<br>Chapter 1.2.3.1 --- Immune system --- p.17<br>Chapter 1.2.3.2 --- Cardiovascular system --- p.18<br>Chapter 1.2.3.3 --- Cell proliferation and differentiation --- p.18<br>Chapter 1.2.3.4 --- Neurological system --- p.19<br>Chapter 1.2.3.5 --- Reproductive system --- p.20<br>Chapter 1.2.3.6 --- Fetal development --- p.21<br>Chapter 1.3 --- The definition of vitamin D deficiency --- p.21<br>Chapter 1.4 --- Vitamin D status and pregnancy --- p.24<br>Chapter 1.4.1 --- Alteration in vitamin D metabolism during pregnancy --- p.24<br>Chapter 1.4.2 --- Factors affecting maternal serum level of 25(OH)D --- p.25<br>Chapter 1.4.3 --- Vitamin D and bone resorption during pregnancy and lactation --- p.27<br>Chapter 1.4.3.1 --- Alteration of calcium metabolism, bone absorption and the role of vitamin D --- p.27<br>Chapter 1.4.3.2 --- Measurement of bone density in pregnant women and babies --- p.33<br>Chapter 1.4.4 --- Current studies on maternal vitamin D status and pregnancy outcome --- p.35<br>Chapter 1.4.4.1 --- Birthweight --- p.35<br>Chapter 1.4.4.2 --- Infection --- p.37<br>Chapter 1.4.4.3 --- Preterm delivery --- p.39<br>Chapter 1.4.4.4 --- Diabetes (DM) and gestational diabetes (GDM) --- p.39<br>Chapter 1.4.4.5 --- Hypertension and preeclampsia --- p.41<br>Chapter 1.4.4.6 --- Multiple pregnancy, muscular symptoms --- p.42<br>Chapter 1.4.4.7 --- Vitamin D supplementation and pregnancy outcome --- p.44<br>Chapter 1.5 --- Defining vitamin D deficiency in pregnancy --- p.45<br>Chapter 1.6 --- Objective of the study --- p.46<br>Chapter Chapter 2: --- Study design and methods --- p.48<br>Chapter 2.1 --- Case recruitment and study design --- p.48<br>Chapter 2.1.1 --- Longitudinal singleton study --- p.49<br>Chapter 2.1.2 --- Cross-sectional study --- p.50<br>Chapter 2.1.2.1 --- Preterm birth (PTB) --- p.51<br>Chapter 2.1.2.2 --- Preeclampsia (PET) --- p.51<br>Chapter 2.1.2.3 --- Gestational diabetes (GDM) --- p.52<br>Chapter 2.1.3 --- Multiple pregnancy study --- p.52<br>Chapter 2.2 --- Measurements --- p.53<br>Chapter 2.2.1 --- Hormonal analysis of serum levels of 25(OH)D and PTH --- p.53<br>Chapter 2.2.2 --- Calculation of monthly intake of vitamin D from diet --- p.55<br>Chapter 2.2.3 --- SoS measurements --- p.56<br>Chapter 2.2.4 --- Ultraviolet radiation strength assessment --- p.59<br>Chapter 2.3 --- Statistical analysis --- p.60<br>Chapter Chapter 3 --- Longitudinal Study on the Level of and Factors Affecting Vitamin D in Singleton Pregnancy --- p.62<br>Chapter 3.1 --- Introduction --- p.62<br>Chapter 3.2 --- Material and method --- p.63<br>Chapter 3.3 --- Statistics --- p.64<br>Chapter 3.4 --- Results --- p.65<br>Chapter 3.4.1 --- Demographic data of the subjects --- p.65<br>Chapter 3.4.2 --- Maternal levels of 25(OH)D and PTH, and the factors affecting their levels --- p.66<br>Chapter 3.4.2.1 --- Distribution of 25(OH)D level and PTH level in the four visits --- p.66<br>Chapter 3.4.2.2 --- Dietary intake of vitamin D and supplementation --- p.69<br>Chapter 3.4.2.3 --- Seasonality and sunlight exposure --- p.73<br>Chapter 3.4.2.4 --- Parity --- p.76<br>Chapter 3.4.3 --- Changes of maternal levels of 25(OH)D and PTH in pregnancy --- p.78<br>Chapter 3.4.4 --- Independent factors related to maternal 25(OH)D level in pregnancy --- p.79<br>Chapter 3.4.5 --- Maternal and fetal 25(OH)D level at delivery --- p.80<br>Chapter 3.4.6 --- Muscular symptoms and other complaints in pregnancy, pregnancy outcome, and their relationships with maternal 25(OH)D level --- p.81<br>Chapter 3.4.7 --- Postnatal recovery and factors related to postnatal level of 25(OH)D and PTH --- p.86<br>Chapter 3.4.7.1 --- Postnatal symptoms and relationship with 25(OH)D and PTH --- p.86<br>Chapter 3.4.7.2 --- The postnatal level of 25(OH)D and PTH in women with different feeding mode --- p.88<br>Chapter 3.4.7.3 --- Independent factors related to postnatal 25(OH)D and PTH level --- p.89<br>Chapter 3.4.7.4 --- Factors related to the change of 25(OH)D and PTH after delivery --- p.90<br>Chapter 3.4.8 --- Correlation between 25(OH)D with PTH in pregnancy and postnatal period --- p.91<br>Chapter 3.5 --- Discussion --- p.92<br>Chapter 3.5.1 --- 25(OH)D level in Chinese pregnant women --- p.92<br>Chapter 3.5.2 --- Factors related to maternal 25(OH)D level --- p.93<br>Chapter 3.5.2.1 --- Dietary and supplementation --- p.93<br>Chapter 3.5.2.2 --- Seasonality and outdoor activity --- p.96<br>Chapter 3.5.2.3 --- Gestational age --- p.98<br>Chapter 3.5.2.4 --- Age and parity --- p.98<br>Chapter 3.5.3 --- Relationship of 25(OH)D level in the cord blood with maternal 25(OH)D level --- p.99<br>Chapter 3.5.4 --- 25(OH)D level and muscular complains in pregnancy --- p.100<br>Chapter 3.5.5. --- Postnatal recovery and 25(OH)D level --- p.101<br>Chapter 3.5.6 --- PTH level in pregnancy and postnatal period --- p.101<br>Chapter 3.6 --- Conclusion --- p.102<br>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<br>Chapter 4.1 --- Introduction --- p.105<br>Chapter 4.2 --- Material and method --- p.106<br>Chapter 4.3 --- Statistics --- p.108<br>Chapter 4.4 --- Results --- p.108<br>Chapter 4.4.1 --- Demographic data --- p.108<br>Chapter 4.4.2 --- Maternal bone density and the changes in pregnancy and postnatal recovery --- p.109<br>Chapter 4.4.2.1 --- Maternal bone density in the first trimester and related factors --- p.109<br>Chapter 4.4.2.2 --- Maternal bone density in the three visits --- p.109<br>Chapter 4.4.2.3 --- The change in maternal bone density in the three visits --- p.110<br>Chapter 4.4.2.4 --- Diversity in the change of bone density in pregnant women --- p.112<br>Chapter 4.4.3 --- Factors related to the changes in bone density --- p.114<br>Chapter 4.4.3.1 --- Changes between the first and the third trimesters --- p.114<br>Chapter 4.4.3.2 --- Change between the third trimester and postnatal visits --- p.116<br>Chapter 4.4.4 --- The bone density in infants and related factors --- p.120<br>Chapter 4.5 --- Discussion --- p.122<br>Chapter 4.5.1 --- Maternal bone density changes in pregnancy and postnatal period --- p.122<br>Chapter 4.5.2 --- Factors related to the maternal bone density changes in pregnancy and postnatal period --- p.124<br>Chapter 4.5.2.1 --- Initial bone density, parity, and BMI --- p.125<br>Chapter 4.5.2.2 --- 25(OH)D and PTH level --- p.126<br>Chapter 4.5.2.3 --- Supplement --- p.127<br>Chapter 4.5.2.4 --- Lactation --- p.128<br>Chapter 4.5.2.5 --- Height --- p.129<br>Chapter 4.5.3 --- Factors related to bone density of the infant. --- p.130<br>Chapter 4.5.3.1 --- Maternal 25(OH)D level --- p.130<br>Chapter 4.5.3.2 --- Gestational age and birthweight --- p.131<br>Chapter 4.5.3.3 --- Maternal bone density change --- p.131<br>Chapter 4.5.3.4 --- The gender of the offspring and feeding method --- p.132<br>Chapter 4.6 --- Conclusion --- p.133<br>Chapter Chapter 5 --- Maternal 25(OH)D Level in Multiple Pregnancy --- p.134<br>Chapter 5.1 --- Introduction --- p.134<br>Chapter 5.2 --- Material and method --- p.135<br>Chapter 5.3 --- Statistics --- p.136<br>Chapter 5.4 --- Results --- p.137<br>Chapter 5.4.1 --- Demographic data of the subjects --- p.137<br>Chapter 5.4.2 --- The level of 25(OH)D in multiple pregnancy and singleton pregnancy --- p.137<br>Chapter 5.4.3 --- Supplementation in multiple pregnancy --- p.140<br>Chapter 5.4.4 --- The change of maternal 25(OH)D and PTH levels in the three trimesters --- p.141<br>Chapter 5.4.5 --- 25(OH)D level in cord blood and its correlation with 25(OH)D level of the sibling --- p.143<br>Chapter 5.4.6 --- Correlation between 25(OH) with PTH in pregnancy --- p.143<br>Chapter 5.5 --- Discussion --- p.144<br>Chapter 5.5.1 --- 25(OH)D level in multiple pregnancy and singleton pregnancy --- p.144<br>Chapter 5.5.2 --- Supplementation in multiple pregnancy --- p.146<br>Chapter 5.5.3 --- Changes of maternal levels of 25(OH)D and PTH in the three trimesters in multiple pregnancy --- p.146<br>Chapter 5.5.4 --- The PTH/25(OH) correlation --- p.147<br>Chapter 5.6 --- Conclusion --- p.148<br>Chapter Chapter 6 --- Maternal level of 25(OH)D in complicated pregnancy --- p.150<br>Chapter 6.1 --- Introduction --- p.150<br>Chapter 6.2 --- Method --- p.153<br>Chapter 6.2.1 --- Preterm birth --- p.155<br>Chapter 6.2.2 --- Preeclampsia --- p.155<br>Chapter 6.2.3 --- Gestational diabetes --- p.156<br>Chapter 6.2.4 --- Fetal growth restriction --- p.157<br>Chapter 6.2.5 --- The association between 25(OH)D level with pregnancy complication --- p.158<br>Chapter 6.3 --- Statistics --- p.159<br>Chapter 6.4 --- Results --- p.160<br>Chapter 6.4.1 --- Setting of the cutoff values of hypovitaminosis D --- p.160<br>Chapter 6.4.2 --- Preterm birth --- p.160<br>Chapter 6.4.3 --- Preeclampsia --- p.164<br>Chapter 6.4.4 --- Gestational diabetes --- p.168<br>Chapter 6.4.4.1 --- Case-control study --- p.168<br>Chapter 6.4.4.2 --- Factors affecting OGTT results --- p.170<br>Chapter 6.4.5 --- Fetal growth restriction --- p.173<br>Chapter 6.5 --- Discussion --- p.179<br>Chapter 6.5.1 --- Adjustment for confounders for case-control study --- p.179<br>Chapter 6.5.2 --- PTB and 25(OH)D level --- p.181<br>Chapter 6.5.3 --- PET and 25(OH)D level --- p.182<br>Chapter 6.5.4 --- GDM and 25(OH)D level --- p.186<br>Chapter 6.5.5 --- FGR and 25(OH)D level --- p.189<br>Chapter 6.5.6 --- Defining vitamin D deficiency in pregnancy --- p.192<br>Chapter 6.6 --- Conclusion --- p.195<br>Chapter Chapter 7 --- Summary --- p.196<br>References --- p.201<br>Chapter Appendix 1 --- Antenatal questionnaire (English/Chinese) --- p.224<br>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.<br>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<br>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.