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Garmendia, M. L., Matus, O., Mondschein, S., & Kusanovic, J. P. (2018). Gestational weight gain recommendations for Chilean women: a mathematical optimization approach. Public Health, 163, 80–86.
Abstract: Objectives: We examined if the guidelines for gestational weight gain (GWG) proposed by the Institute of Medicine (IOM) are the most suitable for Chilean women. Study design: Secondary analysis of records of single full-term births at the Dr. Sotero del Rio Hospital, Santiago, Chile, during 2003-2012 (n = 62,579). Methods: From clinical records, we obtained data regarding maternal age, height, prepregnancy and at delivery weights, pathologies during pregnancy such as gestational diabetes (GDM) and pre-eclampsia, gestational age at delivery, and number of infants born small for gestational age (SGA) and large for gestational age (LGA). We formulated a mathematical model (MM) to determine the GWG range that maximizes the likelihood of a healthy pregnancy (HP) if the recommendation is followed. We defined an HP as one where the mother has no complications such as pre-eclampsia, GDM, SGA, or LGA. Results: Forty-six percent of women had prepregnancy overweight or obesity. The prevalence of GDM, pre-eclampsia, SGA, and LGA were 3%, 1.2%, 9%, and 12%, respectively. An HP was present in 76% of pregnancies, 79% in the underweight group, 79% in normal weight group, 74% in the overweight group, and 67% in obese women. The GWG recommendations given by the MM (14-20 kg for underweight, 6-20 kg for normal weight, 9 -11 kg for overweight, and 6-7 kg for obese) led to higher probabilities of achieving an HP than the ones obtained with the IOM recommendations. Conclusion: The adoption of GWG recommendations based on characteristics of the Chilean population might lead to better short- and long-term health results for pregnant women. (C) 2018 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
Keywords: Pregnancy; Weight gain; Obesity; Pregnancy high risk; Chile
Garmendia, M. L., Mondschein, S., Matus, O., Murrugarra, R., & Uauy, R. (2017). Predictors of gestational weight gain among Chilean pregnant women: The Chilean Maternal and Infant Nutrition Cohort study. Health Care Women Int., 38(8), 892–904.
Abstract: We identified factors associated with gestational weight gain (GWG) in 1,654 Chilean pregnant women with full-term pregnancies. At baseline, we collected information about sociodemographic, gyneco-obstetric, anthropometric, and health-care-related factors. We found that prepregnancy nutritional body mass index was the most important factor related to GWG above recommendations (overweight: ratio of relative risks [RRR] = 2.31, 95% confidence interval [CI, 1.73, 3.09] and obesity: RRR = 2.90, 95% CI [2.08, 4.03]). We believe that women who are overweight/obese at the beginning of pregnancy should be identified because of their higher risk, and that adequate strategies should be designed and implemented to help them achieve a healthy GWG.
Garmendia, M. L., Mondschein, S., Montiel, B., & Kusanovic, J. P. (2020). Trend and predictors of gestational diabetes mellitus in Chile. Int. J. Gynecol. Obstet., 148(2), 210–218.
To examine the temporal trends in gestational diabetes mellitus (GDM) prevalence in Chile, and to determine the main predictors of GDM.
A secondary analysis was conducted of all birth records at Hospital Dr. Sótero del Río, Chile, from January 1, 2002, to December 31, 2015. We excluded those women with pre‐existing type 2 diabetes, those with missing data, and those with unlikely data. GDM was defined as fasting glucose levels >5.55 mmol/L [>100 mg/dL] or >7.77 mmol/L [>140 mg/dL] 2 hours after glucose load in the oral glucose tolerance test. Potential predictors were selected based on prior research and ease of evaluation.
From the original database of 100 758 records, 86 362 women were included in the final cohort. The mean GDM prevalence was 7.6% (95% CI [confidence interval] 7.5%�7.8%), increasing from 4.4% (95% CI 4.0%�4.9%) in 2002 to 13.0% (95% CI 12.0%�13.9%) in 2015. Age, education, marital status, parity, family history of type 2 diabetes, personal history of GDM, hypertension and pre‐eclampsia, alcohol consumption, smoking, and pre‐gestational nutritional status performed well in the prediction of GDM.
One out of eight Chilean pregnant women of medium‐ to low socio‐economic status were found to develop GDM. We identified a set of easy‐to‐capture predictors in the primary health care system that may allow for the early identification of women at high‐risk for the development of GDM.