[Gastrointestinal signs and symptoms during pregnancy and postpartum in a sample of Spanish women]

Physiological Changes and Interactions Between Microbiome and the Host During Pregnancy

In recent years, it has become clear that microbiome play a variety of essential roles in human metabolism, immunity, and overall health and that the composition of these microbiome is influenced by our environment, diet, weight, hormones, and other factors. Indeed, numerous physiological and pathological conditions, including obesity and metabolic syndrome, are associated with changes in our microbiome, referred to as dysbiosis. As a result, it is not surprising that such changes occur during pregnancy, which includes substantial weight gain and significant changes in metabolism and immune defenses. The present review relates physiological changes during pregnancy to alterations in the microbial composition at various sites, including the gut, oral cavity, and vagina. Pregnancy has been linked to such microbial changes, and we believe that, in contrast to certain disease states, these microbial changes are vital for a healthy pregnancy, probably through their influence on the mother’s immunological, endocrinological, and metabolic status.

Diagnósticos de enfermagem da NANDA no período pós-parto imediato e tardio

Ao retornar à comunidade, no período pós-parto, a mulher necessita de atendimento de enfermagem sistematizado. Objetivou-se nesta pesquisa analisar a ocorrência de 22 diagnósticos de enfermagem de interesse no puerpério imediato e tardio. Trata-se de estudo descritivo, do qual participaram 40 puérperas. Realizou-se a coleta de dados no período de fevereiro a maio de 2008, no domicílio das participantes, mediante um encontro com entrevista, exame físico e observação. O julgamento clínico dos diagnósticos foi baseado na Taxonomia II da NANDA. Entre os diagnósticos identificados, destacaram-se: conhecimento deficiente; risco para infecção; integridade tissular prejudicada; amamentação eficaz; ansiedade; nutrição desequilibrada, menos do que as necessidades corporais; disposição para processos familiares melhorados; risco de integridade da pele prejudicada; e insônia. Foram encontrados indícios de novos diagnósticos: risco de amamentação interrompida, risco de amamentação ineficaz. Os resultados indicam áreas para o direcionamento das ações de enfermagem no pré-natal e puerpério e a necessidade de acompanhamento mais próximo da puérpera do que o previsto nas políticas de saúde.

Surfing as a risk factor for gastroesophageal reflux disease

OBJECTIVE

To compare the prevalence of gastroesophageal reflux disease (GERD) in surfers versus nonsurfers who participate in other sports activities based on the hypothesis that paddling in the prone position on hard surfboard surfaces leads to increased intra-abdominal pressure and GERD.

STUDY DESIGN

A questionnaire survey using a modified Gastrointestinal Symptom Rating Scale.

SETTING

Data obtained from surfers and nonsurfer athletes on the island of Oahu in the state of Hawaii.

PARTICIPANTS

One hundred eighty-five surfers and 178 nonsurfers who participate in sports activities.

ASSESSMENT OF RISK FACTORS

Surfer or nonsurfer status, type of surfboard used, frequency of surfing, and duration of surfing experience.

MAIN OUTCOME MEASURES

The prevalence of reflux symptoms at least twice a week (GERD).

RESULTS

The prevalence of GERD was significantly higher in short-board surfers than in nonsurfers with an odds ratio of 4.6 (28% versus 7%, P < 0.001) after adjustment for demographic variables using the multivariate regression model. GERD was more prevalent in short-boarders than long-boarders (28% and 12%, respectively). The prevalence of GERD increased significantly as both the frequency and duration of surfing experience increased (P < 0.001).

CONCLUSION

Surfing is strongly associated with GERD. Short-board surfing appears to have a stronger association with GERD than long-board surfing.

Progesterone, estrogen and pregnancy do not decrease colon myoelectric activity in rats: an in vivo study

BACKGROUND

Progesterone, estrogen and the hormonal complex of pregnancy have been responsible for some degree of colon hypomotility in human pregnancy.

OBJECTIVE

To find out if estrogen, progesterone and the hormonal complex of pregnancy decrease colon myoelectric activity.

METHODS

The study was performed in 37 healthy female rats in which electrodes were implanted on the serosa of the proximal ascendent, distal ascendent, transverse, and descendent colon. We analyzed the records of colon myoelectric activity in vivo in five groups: control, ovariectomized, ovariectomized and treated with estrogen, ovariectomized and treated with progesterone, and pregnant rats.

RESULTS

We found a great variation in myoelectric activity in all groups studied. The mean of electric activity did not show statistical difference among the five groups, but pregnant rats had a statistically significant higher duration of maximum electric activity in all distances from the cecocolon junction.

CONCLUSION

Pregnant rats had a statistically higher duration of maximum electric activity. If we could transpose these results to humans, this increase in duration of colon myoelectric activity could explain, in part, the slight constipation that some pregnant women have.

Constipation during pregnancy: a longitudinal survey based on self-reported symptoms and the Rome II criteria

An increase in the prevalence of constipation during pregnancy has been suggested to occur. We designed a prospective study to evaluate the prevalence of constipation during pregnancy and puerperium, to investigate possible associations with eating habits and lifestyle, and to evaluate the frequency of laxative use. A structured questionnaire was developed addressing demographics, obstetric characteristics, lifestyle, eating habits, variables required for the diagnosis of constipation, and laxative use to evaluate the prevalence of constipation during pregnancy and puerperium. The questionnaire was administered in the obstetric clinic in the first trimester of pregnancy, and by telephone in the second and third trimesters, and in the puerperal period. The prevalence of self-reported constipation in these time periods was 45.4, 37.1, 39.4, and 41.8%, respectively. Prevalence defined by the Rome II criteria for the same time periods was 29.6, 19, 21.8, and 24.7%. These values were similar to the data previously reported for the female population. Agreement between the self-reported and Rome II results was moderate. The self-reported criterion showed high sensitivity in all time periods, using the Rome II criterion as gold-standard. No factor was associated with variations in the prevalence of constipation during pregnancy, though an increase was recorded in the consumption of fruit, vegetables, fiber, and water. The prevalence of constipation during pregnancy and puerperium is similar to that recorded among the female population from the same geographic area.

Gastroesophageal reflux symptoms during and after pregnancy: a longitudinal study

BACKGROUND AND AIMS

Prevalence of gastroesophageal reflux symptoms (GERS) increases during pregnancy, but there are no longitudinal studies on western populations examining their incidence in each trimester. Our aim was to describe the natural history of GERS in pregnancy and to ascertain whether pregnancy might be associated with a higher risk of developing GERS 1 yr postpartum.

METHODS

Pregnant women (<12 wk gestation) and age-matched controls were included. A telephone survey was conducted, covering pregnant women at 12, 24, and 36 wk of gestation and at 1 yr postpartum, using a validated questionnaire. Controls were interviewed at baseline and 21 months later.

RESULTS

Data on 263 pregnant women were analyzed. Incidence of GERS was 25.8% (95% confidence interval [CI] 20.1-31.1%) in the first trimester, 24.3% (95% CI 18.1-30.6%) in the second, and 25.5% (95% CI 18.2-32.8%) in the third. Factors associated with developing GERS in the first trimester were South American origin (odds ratio [OR] 2.75, 95% CI 1.30-5.84) and prepregnancy occasional GERS (OR 3.00, 95% CI 1.35-6.66). Risk factors of GERS in the third trimester were cumulative weight gain during pregnancy (OR 1.18, 95% CI 1.04-1.32) and prepregnancy occasional GERS (OR 3.79, 95% CI 1.08-13.24). Incidence of frequent GERS at 1 yr postpartum was higher in pregnant versus control women (4.7%vs 1.3%, P < 0.05).

CONCLUSIONS

Incidence of GERS is similar across the three trimesters of pregnancy. Accumulated weight gain during pregnancy is associated with a higher risk of GERS in the third trimester. Pregnancy might constitute a risk factor for developing GERS 1 yr postpartum.