Empfehlungen zu Ernährung und Bewegung von Kleinkindern

Monatsschrift Kinderheilkunde -     

Gesundheitliche Auswirkungen des Stillens auf die Mutter

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - Bei den Auswirkungen des Stillens auf die mütterliche Gesundheit kann zwischen Kurzzeit- und Langzeiteffekten unterschieden...     

Predictors of Inflammatory Breast Diseases During Lactation – Results of a Cohort Study

Problem  Inflammatory breast diseases during lactation are major reasons for early weaning.
Method of study  A prospective cohort study was performed to examine the association between stress and inflammatory breast diseases. Psychometric data, cytokine levels in breast milk and blood samples were analysed postpartum (T1). Psychometric data and course of breast feeding were evaluated twelve weeks later (T2). Patients were divided into case- and control-groups (according to the presence of breast diseases).
Results  Mothers of the case group ( n  = 23) were significantly older and showed significantly increased stress levels between T1 and T2 compared with the control group ( n  = 43). Leucocytes in the postpartum blood count were significantly decreased in the case group. There were no significant differences between groups in the concentrations of Th-1- and Th-2-cytokines in breast milk postpartum.
Conclusion  Higher maternal age, postpartum increase in stress perception and low number of leucocytes are associated with a higher incidence of inflammatory breast diseases. Further studies must examine the causality of this effect.     

Quality of care of VLBW neonates: relationship between unit volume and outcome is different between metropolitan and rural regions

Abstract Background: Recent studies from predominantly rural areas in Germany show that neonatal outcome of very low birth weight (VLBW) neonates is (on average) inferior with lower NICU (neonatal intensive care unit) volume. However, there are no data available which show that study results of one specific region can be transferred to other areas with possibly different medical infrastructure and needs. Aim: It was investigated whether a systematic difference of treatment quality between smaller (1000-2000 births/year; 3000 births/year; >20 neonatal beds) exists. Furthermore, the results are compared to data from a rural region in order to discuss transferability between regions. Methods: Retrospectively, completely, and for the first time, the data of all centres which treat VLBW neonates (相似文献   

Gestational diabetes mellitus causes changes in the concentrations of adipocyte fatty acid-binding protein and other adipocytokines in cord blood

OBJECTIVE

To determine the concentrations of adipocyte fatty acid–binding protein (AFABP) and other adipocytokines in maternal and cord serum of pregnant women with gestational diabetes mellitus (GDM) and of control subjects and to relate them to indexes of insulin sensitivity.

RESEARCH DESIGN AND METHODS

In 86 control and 98 GDM pregnant women, venous blood was collected before vaginal delivery and arterial blood from cord immediately after delivery. Serum insulin and adipocytokines were measured by enzyme-linked immunosorbent assay (ELISA).

RESULTS

GDM women had higher prepregnancy BMI, and data were adjusted for it. Maternal serum insulin, insulin-to-glucose ratio, homeostasis model assessment (HOMA), AFABP, and retinol-binding protein 4 (RBP4) were higher and adiponectin was lower in GDM than in control subjects, whereas serum glucose, insulin, insulin-to-glucose ratio, HOMA, nonesterified fatty acids, and RBP4 were higher and glycerol, AFABP, and adiponectin were lower in cord blood serum of GDM than of control subjects. AFABP and adiponectin in cord serum of control subjects were higher than in maternal serum; in GDM women no difference was found for AFABP in cord versus maternal serum, although adiponectin remained higher in cord. Values of leptin in both groups were lower in cord than in maternal serum, and those of RBP4 were lower in only GDM women.

CONCLUSIONS

It is suggested that fetal tissues are the main source of cord arterial serum AFABP, and in GDM fetuses AFABP values correlate with adiposity markers. A downregulation of adiponectin and upregulation of RBP4 in GDM mothers and their fetuses may be related to their insulin-resistant condition, whereas changes in AFABP do not seem to be related.Pregnancy is associated with substantial changes in maternal metabolism, which provide sufficient energy and nutrients to the fetus. Glucose is the primary source of energy for the fetoplacental tissues but, because the fetus only produces glucose under extreme conditions, it is necessary to ensure its transport through the placenta. In this context, the mother develops a state of insulin resistance during midpregnancy and progressing through the third trimester, which reduces the consumption of glucose by maternal tissues and increases gluconeogenesis enabling a sufficient supply of glucose to the fetus (1). This causes a positive maternal-fetal glucose gradient, which facilitates its placental transfer. However, in a substantial proportion of pregnancies, the insulin-resistant condition is greatly increased and gestational diabetes mellitus (GDM) develops (2); the consequent adverse metabolic state results in complications for the mother, the fetus, and the neonate (3).The mechanisms responsible for the development of GDM are unclear, but mechanisms similar to those in type 2 diabetes have been implicated (4), supporting the notion that the two conditions have similar underlying pathophysiology. Adipose tissue secretes several specific proteins called adipocytokines that modulate the action of insulin in different tissues (5), suggesting that alterations in the expression and secretion of these factors may be linked to GDM and related diseases. Recently, adipocyte fatty acid–binding protein (AFABP), a member of the mammalian intracellular fatty acid–binding protein multigene family (6), was described as a novel adipocytokine. This protein is responsible for intracellular fatty acid trafficking and contributes to the regulation of hormone-sensitive lipase activity (7). Moreover, mice deficient in AFABP are protected from development of hyperinsulinemia, hyperglycemia, and insulin resistance (8,9). Recent studies have shown that AFABP is present in human serum (10), and its levels are associated with insulin resistance and type 2 diabetes (10,11). Therefore, in adults, AFABP concentrations have been considered an independent predictor of diabetes, contributing to the control of systemic insulin sensitivity and of lipid and glucose metabolism. So far there is only one study where the level of AFABP in GDM women at midpregnancy has been determined (12), and no information is available on its levels either during late pregnancy or in cord serum. Thus, the objectives of the current study were to measure the concentrations of AFABP in maternal and cord serum of control and GDM pregnant women and to examine its relationship with glycemia and other related variables.     

Influence of the birth clinic on breastfeeding

A decrease of breastfeeding culture could be observed since the 1950's. However in the 1980's the WHO and UNICEF began engaging in campaigns for breastfeeding since the benefits for mother and child are evident. In 1990 UNICEF set up the "10 steps to successful breastfeeding" that gave birth clinics around the world "guidelines" that would initiate an unproblematic breastfeeding relationship between mother and child. These guidelines can be understood as measures toward increasing staff motivation, training and instruction as well as actually helping parents and increasing their motivation. Further points cover the optimal beginning of breastfeeding and aspects of complementary feeding. Certification of departments by internationally renowned observers is a means of implementing and securing best quality breastfeeding encouragement in the birth clinics. The positive effects of this promotion on the ratio of mothers breastfeeding and thus in respect to childreńs health could be proved by randomised studies. The experience gained in the Obstetrical Department of the Vivantes Humboldt Clinic is described.     

How Many Sonograms Are Needed to Reliably Predict the Absence of Fetal Overgrowth in Gestational Diabetes Mellitus Pregnancies?

OBJECTIVE

Serial measurements of the fetal abdominal circumference have been used to guide metabolic management of pregnancies complicated by gestational diabetes mellitus (GDM). A reduction in the number of repeat ultrasound examinations would save resources. Our purpose was to determine the number of serial abdominal circumference measurements per patient necessary to reliably predict the absence of fetal overgrowth.

RESEARCH DESIGN AND METHODS

Women who had GDM were asked to return for repeat ultrasound at 3- to 4-week intervals starting at initiation of care (mean 26.9 ± 5.7 weeks). Maternal risk factors associated with fetal overgrowth were determined.

RESULTS

A total of 4,478 ultrasound examinations were performed on 1,914 subjects (2.3 ± 1.2 per pregnancy). Of the 518 women with fetal abdominal circumference >90th percentile, it was diagnosed in 73.9% with the first ultrasound examination at entry and in 13.1% with the second ultrasound examination. Of the fetuses, 85.9 and 86.9% of the fetuses were born non-large for gestational age (LGA) when abdominal circumference was <90th percentile at 24–27 weeks and 28–32 weeks, respectively, and 88.0% were born non-LGA when both scans showed normal growth. For those women who had no risk factors for fetal overgrowth (risk factors: BMI >30 kg/m², history of macrosomia, and fasting glucose > 100 mg/dl), the accuracy of prediction of a non-LGA neonate was 90.0, 89.5, and 95.2%. The predictive ability did not increase with more than two normal scans.

CONCLUSIONS

The yield of sonographic diagnosis of a large fetus drops markedly after the finding of a fetal abdominal circumference <90th percentile on two sonograms, which excludes with high reliability the risk of a LGA newborn. The ability was enhanced in women who had no risk factors for neonatal macrosomia.The recommendations for diagnosis and treatment of gestational diabetes mellitus (GDM) of the Fifth International Workshop-Conference on Gestational Diabetes Mellitus (1) suggest consideration of fetal growth patterns to guide metabolic management of pregnant women with GDM. Estimation of fetal weight, particularly at term and in fetuses with high neonatal weight, is not as precise as is desirable (2). However, enlarged size (3–6) and accelerated growth velocity of the fetal abdominal circumference in the third trimester is known to predict large-for-gestational-age (LGA) birth weight (7). Previous randomized studies have demonstrated that measurement of the fetal abdominal circumference throughout pregnancy in women who have GDM is useful to identify pregnancies at high risk for fetal overgrowth and therefore in need of intensified intervention (8–11). On the other side, relaxed glycemic goals had been allowed in women with sonographic evidence of normal fetal growth. Besides saving insulin therapy, this approach reduced the rate of fetal growth restriction in the fetuses of those women. Published protocols for fetal growth–based management require sonographic determination of fetal abdominal circumference at the time of diagnosis of GDM (8–11) followed by repeat examinations at 2 (11)- to 4-week intervals (9,10). Serial sonographic examinations are costly and require the time and expertise of experienced ultrasonographers and/or physicians.The purpose of our study was to determine the number of sequential ultrasound examinations necessary not to miss development of an enlarged abdominal circumference during pregnancy and to assure a low risk for a LGA neonate with a great degree of certainty when the scans suggest normal fetal growth. In addition, we wished to evaluate whether the absence of maternal risk factors for neonatal macrosomia would enhance the accuracy of the ultrasound examination predicting a non-LGA neonate.