STATO DI NUTRIZIONE MATERNO, ESITI GRAVIDICI E OUTCOMES OSTETRICI: STUDIO OSSERVAZIONALE PROSPETTICO IN DONNE DI ORIGINE CAUCASICA

UNIVERSITÀ DEGLI STUDI DI MILANO Facoltà di Medicina e Chirurgia SCUOLA DI DOTTORATO in SCIENZE FISIOPATOLOGICHE, NEUROPSICOBIOLOGICHE E ASSISTENZIALI DEL CICLO DELLA VITA DIPARTIMENTO di Scienze Biomediche e Cliniche “Luigi Sacco” CORSO DI DOTTORATO in Scienze Assistenziali del Ciclo della Vita - CICLO XXVII ABSTRACT DELLA TESI DI DOTTORATO DI RICERCA STATO DI NUTRIZIONE MATERNO, ESITI GRAVIDICI E OUTCOMES OSTETRICI: STUDIO OSSERVAZIONALE PROSPETTICO IN DONNE DI ORIGINE CAUCASICA Settore scientifico disciplinare MED/40 Ginecologia e Ostetricia Tesi di Dottorato di Elena Isabel Liguori Matricola R09522 TUTOR: Chiar.mo Prof. Enrico Mario Ferrazzi COORDINATORE: Chiar.mo Prof. Roberto Weinstein A.A. 2013/2014 ABSTRACT In the bibliography the Mediterranean diet is associated with positive health effects in the general population, such as a lower incidence of cardiovascular diseases, diabetes and obesity. There is limited data on pregnant women. The relationship between nutrition in pregnancy and obstetric outcome was investigated. In particular the adherence to the Mediterranean diet of caucasian pregnant was analyzed, because it’s already considered a positive prognostic index in the normal population, to see if the dietary pattern is correlated with a lower incidence of complications in pregnancy related to poor nutrition and excessive weight, and then to an improvement of neonatal outcomes. 127 caucasian woman were enrolled voluntarily, pertaining to outpatient of the I.C.P. Buzzi Children’s Hospital, in Milan, and these were followed in the three trimesters of pregnancy. The trend of the nutritional profile during pregnancy was analyzed with a standardized questionnaire, to be able to detect the degree of adherence to the mediterranean diet, and the maternal weight gain has been detected combined with anthropometric measurements (skinfold and circumferences). All data collected were analyzed and were related with medical history, pregnant examinations routine, obstetric and neonatal outcomes. Of the 127 women who partecipated in the first meeting 97 have completed the course. The sample of urban Caucasian women is rather uniform, mainly composed of primigravida, nonsmokers, with a high cultural level and 79.5% of the sample is normal weight, with an average BMI 21.8. The nutritional profile shows that there are not significant differences in the Mediterranean score in the three trimesters of pregnancy, but only about 16% reaches the minimum cut off of adhesion and is correlated directly and significantly with the age of the mother (r = 0:23 , p = 0.01). In particular it a low fish consumption was noted (only 4% reported consuming at least 3 times a week), legumes (only 10.6% reported consuming at least three times a week), dried fruit and nuts (only 22.4% reported consuming at least once a week). Of these women, those underweight and normal weight had an average weight gain of 13 kg and then in the range, overweight women instead took an average of 14 kg compared to 11 kg indicated by the IOM. The Mediterranean score detected at the end of pregnancy was inversely correlated (of borderline significance: 00:07) with the increase in weight, and can be correlated with the variation of the subscapular fold, which is skinfold more indicative of the change in fat mass. The weight of the newborn was correlated significantly to maternal weight, the folds of subcutaneous fat measured at the end of pregnancy and maternal waist circumference. The weight change between the first and third trimester was associated to the change of the folds and thus significantly associated to the increase in fat mass, which is in turn associated with weight.