MEASURI NG THE ENERGY SPENT BY PARTURI ENT W OMEN I N FASTI NG AND I N
I NGESTI NG CALORI C REPLACEMENT ( HONEY)
Célia Regina Maganha e Melo1 José Car los Per açoli2
Melo CRM, Per açoli JC. Measu r in g t h e en er gy spen t by par t u r ien t w om en in f ast in g an d in in gest in g calor ic r eplacem ent ( honey ) . Rev Lat ino- am Enfer m agem 2 0 0 7 j ulho- agost o; 1 5 ( 4 ) : 6 1 2 - 7 .
This r esear ch aim s t o m easur e t he ener gy spending in par t ur ient w om en of low gest at ion r isk. Par t icipant s w er e select ed r andom ly and subm it t ed t o fast ing ( n= 15; Gr oup I ) or honey ingest ion ( n= 15; Gr oup I I ) . Dat a w er e collect ed by m eans of capillar y blood values and hear t fr equency m onit or ing. The pair ed t - t est w it h a 5% significance level and Tukey’s m et hod w er e used in st at ist ical analysis. The r esult s show ed t hat honey ingest ion did not pr om ot e an ov er load in t he m ot her ’s glucose; t he lact at e r esponse dem onst r at ed t hat t he subst r at e offer ed w as w ell used; t he car dior espir at or y r at e dem onst r at ed “ good per for m ance” for bot h gr oups; t he t ot al en er gy spen t du r in g labor dem on st r at ed t h at car boh y dr at e in gest ion ex er t s sign if ican t in f lu en ce, im pr ov in g m at er n al an aer ob ic p er f or m an ce; t h e g r ou p w h ich r em ain ed in f ast in g p r esen t ed , im m ed iat ely af t er lab or , higher lev els of lact at e, show ing t he or ganism ’s effor t s t o com pensat e for t he ener gy spent .
DESCRI PTORS: honey ; ener gy m et abolism ; lact ic acid; blood glucose
MEN SURACI ÓN DE LA EN ERGI A DESPEN DI DA EN EL AYUN O Y EN EL APORTE
CALÓRI CO ( MI EL) EN PARTURI ENTAS
Est e est u d io t ien e com o ob j et iv o m en su r ar el g ast o en er g ét ico d e p ar t u r ien t as d e b aj o r iesg o d e gest ación. Las par t icipant es han sido seleccionadas en dos gr upos de m aner a aleat or ia y som et idas a ay uno ( n= 15; Gr upo I ) e ingest ión de m iel ( n= 15; Gr upo I I ) . Los dat os han sido colect ados a par t ir de los valor es de la san gr e capilar y m on it or de fr ecu en cia car díaca. Par a el an álisis est adíst ica h an sido em pleados el t est t par eado, y el m ét odo de Tukey . Los r esult ados han m ost r ado que la ingest ión de m iel no pr ov ocó sobr ecar ga en la glicem ia m at er n a; la r espu est a del lact at o dem ost r ó qu e el su bst r at o of r ecido f u e bien u t ilizado; los ín d ices d e cap acid ad car d ior r esp ir at or ia h an d em ost r ad o “ b u en d esem p eñ o” p ar a los d os g r u p os; el g ast o en er g ét ico t ot al d u r an t e el t r ab aj o d e p ar t o d em u est r a q u e la in g est ión d e car b oh id r at o t ien e in f lu en cia significat iv a, m ej or ando el desem peño anaer óbico m at er no; el gr upo que ha per m anecido en ay uno pr esent ó, in m ediat am en t e despu és del par t o, n iv eles de lact at o m ás alt os, dem ost r an do el esfu er zo del or gan ism o en com pen sar la en er gía gast a.
DESCRI PTORES: m iel; m et abolism o ener gét ico; ácido láct ico; glucosa de la sangr e
MENSURAÇÃO DA ENERGI A DESPENDI DA NO JEJUM E NO APORTE CALÓRI CO ( MEL)
EM PARTURI ENTES
Est e est udo t em com o pr opost a m ensur ar o gast o ener gét ico de par t ur ient es de baixo r isco gest acional. As par t icipant es for am selecionadas em dois gr upos de m aneir a aleat ór ia e subm et idas a j ej um ( n= 15; gr upo I ) e ingest ão de m el ( n= 15; gr upo I I ) . Colet ar am - se dados m ediant e v alor es do sangue capilar e m onit or de f r eq ü ên cia car d íaca. Par a a an álise est at íst ica em p r eg ou - se o t est e t p ar ead o e o m ét od o d e Tu k ey . Os r esu lt ados m ost r ar am qu e a in gest ão de m el n ão pr ov ocou sobr ecar ga n a glicem ia m at er n a; a r espost a do lact at o dem on st r ou qu e o su bst r at o ofer ecido foi bem u t ilizado; os ín dices de capacidade car dior r espir at ór ia dem onst r ar am “ bom desem penho” par a os dois gr upos; o gast o ener gét ico t ot al dur ant e o t r abalho de par t o dem on st r a qu e a in gest ão de car boidr at o t em in flu ên cia sign ificat iv a, m elh or an do o desem pen h o an aer óbico m at er no; o gr upo que per m aneceu em j ej um apr esent ou, im ediat am ent e após o par t o, nív eis de lact at o m ais elev ados, dem on st r an do o esfor ço do or gan ism o par a com pen sar a en er gia despen dida.
DESCRI TORES: m el; m et abolism o ener gét ico; ácido láct ico; glicem ia
1 Obst et r ic Nur se, PhD, Pr ofessor, Under graduat e and Graduat e Nur sing Depar t m ent , Sagrado Cor ação Univer sit y, Brazil, e- m ail: crm m [email protected] .br ; 2 MD, Adj unct Pr ofessor, Bot ucat o Medical School at t he Paulist a St at e Univer sit y “ Júlio de Mesquit a Filho”, Brazil, e- m ail: j [email protected] .br
I NTRODUCTI ON
T
h e f et u s n eed s g lu cose an d am in o acid s f or it s dev elopm en t an d gr ow t h , w h ich su bm it s t h epr egn an t w om an t o t h e con st an t dem an d f or t h ese
subst r at es in or der t o m eet it s needs( 1).
Wh en labor is pr olon ged an d t h e su pply of
glucose is scarce, gluconeogenesis can be insufficient .
Du r in g n or m al labor, t h e con cen t r at ion of f r ee f at t y
a ci d s a n d k e t o n e b o d i e s i n cr e a se s, l e a d i n g t o a
g r eat er m ob ilizat ion of ot h er su b st r at es ot h er t h an
glucose and a r elat iv e decr ease of car bohy dr at es( 2- 3).
Fa s t i n g r e d u c e s t h e a v a i l a b i l i t y o f
ca r b o h y d r a t e s f o r t h e e f f o r t s d e m a n d e d i n l a b o r,
m a k i n g t h e o r g a n i sm m e t a b o l i ze f a t i n o r d e r t o
gener at e ener gy. Ther efor e, t he availabilit y of am ino
acids in t he m ot her ’s and fet us’ blood is dim inished,
w hile t he fat t y acids and k et ones incr ease( 4).
I t is w ell know n t hat , dur ing physical act ivit y,
t he consum pt ion of energy is cor r elat ed t o it s dur at ion
an d t h e en er g y sp en t( 5 ). Lab or can t ak e h ou r s an d
co n seq u en t l y r eq u i r es g r ea t en er g y co n su m p t i o n .
During long periods of physical act ivit y, t he anaerobic
environm ent is used, inducing t he elevat ion of lact at e
l e v e l s a n d d e c r e a s e i n b l o o d p H . I n l o w - r i s k
part urient s, t he m oderat e increase in m at ernal lact at e
and slight decrease in pH sust ain t he hypot hesis t hat
norm al labor, alt hough it requires physical effort , does
not pr oduce a not able O2 deficit , w hich w ould lead t o
an anaer obic m et abolism as sour ce of ener gy( 6).
I n l o w - r i s k p a r t u r i e n t s , t h e m e t a b o l i c
hom eost asis pr obably occur s due t o t he nat ur e of t he
u t er in e con t r act ion s, w h ich ar e in t er m it t en t , an d by
t h e a d e q u a t e o x y g e n a t i o n d u r i n g t h e m u s c l e
r elax at ion per iods( 6 ).
The oxidat ive envir onm ent involves t he m aj or
par t of ener gy dem ands dur ing labor, w hile glucose is
t h e m a i n m a t e r n a l s o u r c e o f e n e r g y a s w e l l a s
e n e r g e t i c f u e l f o r t h e f e t u s . H y p o x i a a n d f e t a l
h y p e r g l y c e m i a c a n i n c r e a s e t h e p r o d u c t i o n o f
m a t er n a l a n d f et a l l a ct a t e, r esu l t i n g i n m et a b o l i c
acidosis( 7 ).
I n classic lab or car e, it is u su al t o r est r ict
or al n u t r it ion an d adm in ist r at e in t r av en ou s flu ids t o
pr ev ent or t r eat dehy dr at ion, k et osis and elect r oly t e
u n balan ce( 8 ). Th e u se of in t r av en ou s f lu id can h av e
adv er se effect s on m at er nal w ell- being, such as t he
o v e r l o a d o f f l u i d s, d i sco m f o r t a n d r e st r i ct i o n o f
m o v e m e n t s , a n d c a n a l s o c a u s e h y p o n a t r e m i a ,
h y p er g ly cem ia an d su b seq u en t h y p og ly cem ia( 8 - 9 ) in
t h e f et u s/ n ew bor n .
Alt hough t he int ravenous infusion is necessary
in m any obst et r ic cir cum st ances, for t he m edicat ion
and anest hesia adm inist r at ion, it is not consider ed a
f u l l y secu r e su b st i t u t e f or f ood an d l i q u i d s d u r i n g
labor( 9 ).
I t i s cu r r e n t l y r e co m m e n d e d f o r l o w - r i sk
pr egnant w om en in t he act ive phase of labor t o ingest
sm all qu an t it ies of clear f lu ids, su ch as w at er, f r u it
j u ice w it h ou t p u lp, t ea, cof f ee an d sod a. How ev er,
t h er e ar e n o st u d ies in f or m in g ab ou t t h e ad eq u at e
nut r it ional diet dur ing labor, quant it y t o be ingest ed,
and evaluat ion of r isk/ benefit for m ot her and fet us( 10). I t i s est i m a t ed t h a t t h e ex cessi v e en er g y
spent dur ing labor can be com pensat ed by a calor ic
r eplacem en t ; w it h ou t w h ich t h e or gan ism w eak en s,
si n ce t h e co m b u st i o n su p p l y i s p e r f o r m e d t o t h e
d et r im en t of t issu es. Th u s, w e ch ose f or est f low er
h o n e y, w h i c h i s a n i n n o c u o u s f o o d r i c h i n
car bohydr at es, w hich ar e im m ediat ely assim ilat ed and
c a p a b l e o f p r o v i d i n g e n e r g y, s t r e n g t h e n i n g t h e
m uscles, im pr ov ing r esist ance, fav or ing r ecov er y and
allow ing for st r ong and pr olonged effor t( 11).
This st udy aim ed t o offer for est flow er honey
t o t he par t ur ient s in or der t o assess and m easur e t he
dif f er en ces bet w een t h e t w o gr ou ps u n der dif f er en t
t r eat m ent s ( in fast ing and cont r olled food supply) , so
as t o con f ir m t h e h y p ot h esis t h at h on ey im p r ov es
m at er n al per for m an ce du r in g labor an d deliv er y.
SUBJECTS AND METHOD
Th is is a p r osp ect iv e an d r an d om st u d y w it h
3 0 p a r t u r i e n t s r e g i s t e r e d i n t h e S i n g l e H e a l t h
S y s t e m , w h o r e c e i v e d c a r e d u r i n g l a b o r a n d
ch i l d b i r t h a t t h e Sa n t a I sa b el Ma t er n i t y Ho sp i t a l
-Bau r u , SP, Br azil, ag r eed t o p ar t icip at e in t h e st u d y
a f t e r b e i n g i n f o r m e d a n d c l a r i f i e d a b o u t t h e
r esear ch . Th e p r esen t st u d y w as ap p r ov ed b y t h e
I n s t i t u t i o n a l Re v i e w B o a r d f r o m t h e S a g r a d o
st r at if ied in t w o g r ou p s b y r an d om p oolin g : Gr ou p
I ( f a st ) a n d Gr o u p I I ( h o n e y ) . Th o se co n si d e r e d
el i g i b l e f o r t h e st u d y w er e i n l o w - r i sk p r eg n an cy,
ag e b et w een 1 8 an d 2 5 y ear s, w h i t e, g est at i o n al
ag e b et w een 3 8 an d 4 0 w eek s, in t h e lat en t p h ase,
p ar it y f r om 0 t o I V, w it h vag in al ch ild b ir t h .
Th e f a c t o r h o n e y w a s s t u d i e d i n t h e
exper im ent , and it s effect w as com par ed bet w een t he
t w o gr ou ps. I n each gr ou p, t h e m ean an d st an dar d
er r or w er e calcu lat ed f or all t h e r epor t ed at t r ibu t es
a n d t h e r e su l t s w e r e co m p a r e d u si n g t h e Pa i r e d
St udent ’s t t est w it h a significance lev el of 0.05. For
t h e c o n s t a n t s b e t w e e n t h e p a i r s o f m e a n s , t h e
m inim um significant differ ence w as calculat ed ( m sd)
f o r α= 0 . 0 5 , u s i n g Tu k e y ’ s m e t h o d . W h e n
0.05< p< 0.10, a t endency t o significance w as r epor t ed
( p i s t h e p r o b a b i l i t y o f w r o n g l y c o n c l u d i n g
sig n if ican ce) .
Gr oups GI and GI I , com posed of 15 w om en
e a c h , w e r e e v a l u a t e d e v e r y h o u r r e g a r d i n g t h e
a e r o b i c t h r e sh o l d b y t h e i n d i r e ct a sse ssm e n t o f
m ax im u m ox y g en con su m p t ion ( VO2m ax ) , t h r ou g h
t he cont rol of cardiac frequency w it h a Polar® m onit or,
m od el S6 1 0 w it h I R I n t er f ace I n f r ar ou g e. Cap illar y
blood collect ion w as per for m ed for lact at e dosage in
t h e Accu t r e n dÒ La ct a t e a n a l y ze r a n d f o r g l u co se dosage in a Glucosim et er Adv ant age®. Gr oup I I w as
su b m it t ed t o or al in g est ion of 3 . 5 g r am s of h on ey,
independent ly of t he pr oxim it y of fet al expulsion. For
b a se l i n e e n e r g y e x p e n d i t u r e ( BEE) a n d t h e t o t a l
ener gy ex pendit ur e ( TEE) w it hin 24 hour s, equat ions
t h at p r ev i ew t h e en er g et i c n eed s i n h eal t h y n o n
-t r ained indiv iduals w er e used:
( BEE( Kcal/ 24h) = 65.51 + 9.56 x w eight ( Kg)
= 1 . 8 5 x He i g h t ( cm ) - 4 . 6 8 x Ag e ( y e a r s) a n d
( TEE= 1.674 x 1.2 ( act ivit y fact or ) x 1.2 ( st r ess fact or )
The value 1.2 w as used for t he act ivit y fact or
( confined t o bed) , since it w as t he w om en’s choice t o
st ay in bed, and t he value of 1.2 for t he st r ess fact or
( sm all sur ger y ) , since all of t hem w er e subm it t ed t o
episiot om y an d per in eal su t u r e.
Equat ions( 13) for sub m ax im um t est ing w er e
also u sed ( car diac f r equ en cy an d VO2) du r in g labor
( MCF= 2 0 5 - ( 0 . 4 1 x age) f or u n t r ain ed in div idu als( 1 3 )
for w om en ( VO2m ax = 65.81 - 0.1847 x CF fr om t he
end of t he t est ) .
I n b o t h g r o u p s , t h e l a s t c a p i l l a r y b l o o d
col l ect i o n w as p er f or m ed i n t h e f i f t h m i n u t e af t er
d e l i v e r y. Th e Po l a r® m o n i t o r w a s t u r n e d o f f t e n
m inut es aft er bir t h.
The pregnant wom en’s initial weight was taken
from the first notes m ade on the prenatal card and the
final weight was checked at the m om ent of hospitalization
on a m echanical balance Filizola® Model 31. All of them
had their delivery induced, with a m edical prescription of
intravenous infusion with 0.9% physiological serum 0.9% ,
using a 5U am poule of oxytocin. The nutritional inform ation
and food science analysis of the honey were perform ed
at the Laboratory of the Veritas Foundation at the Sagrado
Coração Universit y in Bauru.
RESULTS
A t ot al of 32 low - r isk par t ur ient w om en w er e
inv it ed t o par t icipat e in t he st udy. Am ong t hose w ho
ad h er ed t o t h e st u d y, t w o w er e ex clu d ed f r om t h e
an aly sis becau se t h ey pr esen t ed f u n ct ion al dy st ocia
and w er e r efer r ed t o cesar ean sect ion.
Th e h om ogen eit y v ar iables bet w een GI an d
GI I ev idenced t hat t he par t ur ient s w er e r espect iv ely
21 and 20 year s olds, init iat ed pr enat al car e bet w een
13 and 14 w eek s of pr egnancy and st ar t ed labor at
3 9 w e e k s . Th e t w o g r o u p s s t u d i e d a r e s i m i l a r
r egar ding w eight in t he fir st pr enat al consult at ion ( 53
t o 55 kg) and final w eight ( 64 t o 67Kg) , height ( 1.60
t o 1 . 6 2 ) , labor du r at ion ( 2 h 3 6 m in t o 3 h 0 3 m in ) an d
fast ing dur at ion ( 8h55m in t o 10h40m in) at t he st ar t
of dat a collect ion ( Table 1) .
Table 1 - Mean and st andar d er r or of t he hom ogeneit y
v ar iables bet w een Gr oups GI ( fast ) and GI I ( honey )
at t he beginning of dat a collect ion. Baur u, 2004
s e l b a i r a V s p u o r G I
G GII
n a e
M SE Mean SE p*
) s r a e y ( e g
A 21.80 3.12 20.80 2.37 0.38
) s k e e w ( d e t a i t i n i l a t a n e r
P 13.40 3.77 14.27 3.21 0.47
) s k e e w ( y r e v il e d t a e g a l a n o i t a t s e
G 39.00 0.92 39.27 0.88 0.38
) g K ( t h g i e w l a i t i n
I 55.20 10.98 55.87 9.14 0.20
) g K ( t h g i e w l a n i
F 64.33 11.62 67.87 951 0.44
) m ( t h g i e
H 1.60 004 1.62 0.05 0.35
) h ( n o i t a r u d r o b a
L 2.60 0.91 3.06 1.41 0.34
) h ( n o i t a r u d g n i t s a
F 10.67 3.88 8.93 4.28 0.14
The glucose level, evaluat ed during labor, did
not present ed st at ically significant differences, neit her
in t h e gr ou p w h o f ast ed n or in t h e gr ou p t o w h om
honey w as offer ed. Likew ise, t he lact at e value of t he
g r ou p t o w h om h on ey w as of f er ed d id n ot p r esen t
st at ically significant differences w hen com pared t o t he
value of t he gr oup w ho fast ed. I n t he post - labor per iod,
t here w as no st at ically significant difference in glucose
levels bet w een t he t w o gr oups, alt hough lact at e levels
w er e higher for gr oup I in t he fir st and fift h m inut e
( Table 2 ) .
Table 2 - Mean an d st an dar d er r or of glu cose ( m g/
dL) and lact at e ( m m ol/ L) of gr oups GI and GI I dur ing
labor, childbirt h and in t he first and fift h m inut es aft er
bir t h. Baur u, 2004
e m i T s p u o r G I
G GII
n a e
M SE Mean SE p*
y r e v i l e D
T0 Glucose 81.00 +7.15 80.13 +7.98 0.76 e t a t c a
L 2.54 +0.73 2.66 +0.64 0.64
h
1 Glucose 84.00 +877 82.46 +4.20 0.30
e t a t c a
L 2.48 +0.58 2.90 +0.68 0.04
h
2 Glucose 87.13 +8.95 88.53 +7.60 0.59
e t a t c a
L 2.71 +0.56 2.93 +0.78 0.27
y r e v i l e d -t s o P
1stmin Glucose 100.20 +9.89 103.80 +5.29 0.28
e t a t c a
L 4.68 +1.25 3.74 +0.73 0.02
5thmin Glucose 95.47 +10.30 102.60 +6.83 0.06
e t a t c a
L 4.51 +1.14 3.48 +0.74 0.02
* Pair ed St udent ’s t t est
Th e v alu es of b aselin e en er g y ex p en d it u r e
( BEE) an d t ot al en er g y ex p en d i t u r e ( TEE) d i d n ot
present significant differences bet w een t he t w o gr oups
under st udy ( Table 3) .
Table 3 - Mean and st andar d er r or of baseline ener gy
expendit ur e ( BEE) and t ot al ener gy expendit ur e ( TEE)
i n 2 4 h o u r s, a n d m a t e r n a l a e r o b i c ca p a ci t y ( su b
m ax im u m t est ) du r in g labor in t h e gr ou ps st u died.
Baur u, 2 0 0 4
e c n a m r o f r e P s p u o r G I
G GII
n a e
M SE Mean SE p*
E E
B 1171.06 ±106.941209.55 ±88.06 0.35
E E
T 1616.06 ±147.581669.18±121.53 0.35
m u m i x a m b u S t s e T
{
FC 141.00 ±30.24 145.60 ±10.18 0.59
O
V 2máx 39.76 ±5.59 39.00 ±1.88 0.50
* Pair ed St udent ’s t t est
To calculat e t he ener gy spent ( Kcal) , t he t ot al
en er g y ex p en d it u r e d u r in g lab or w as u sed ( TEEL) ,
an d it w as v er if ied t h at t h e m ean en er gy spen t by
t hose w ho ingest ed honey w as higher t han for t hose
w ho fast ed ( Table 4) .
Table 4 - Mean an d st an dar d er r or of en er gy spen t
( Kcal) dur ing labor. Baur u, 2004
r o b a L s p u o r G I
G GII
n a e
M SE Mean SE p*
t n e p s y g r e n
E 294.73 ±137.92 519.73 ±261.17 0.01
* Pair ed St udent ’s t t est
DI SCUSSI ON
Th e st r en g t h in v olv ed in lab or in clu d e t h e
st r en gt h of t h e u t er u s, w h ich ex pels t h e f et u s, an d
t he effor t t hat m ust ov er com e t he r esist ance offer ed
b y t h e cer v ices, so t h at d ilat at ion occu r s, an d t h e
frict ion creat ed by t he t issues of t he canal during t he
fet us’s passage( 1 4 ).
Th e r e a r e p e cu l i a r ch a r a ct e r i st i cs o f t h e
m y om et r iu m m u scle w h en com par ed t o t h e sk elet al
m u scle. Th ese differ en ces ar e an adv an t age for t h e
m y om et r ium in t he efficiency of ut er ine cont r act ions
and in t he fet us’ det achm ent because t he degr ee by
w hich t he sm oot h m uscle cells ar e shor t ened dur ing
cont ract ion is higher t han t hat reached in t he st riat ed
m uscle cells( 14).
The effor t can be exer t ed in any dir ect ion in
t he cells of t he sm oot h m uscle because t he fine and
t h i ck f i l am en t s ar e o r g an i zed i n l o n g an d r an d o m
bundles by all cells, pr ov iding ev en m or e shor t ening
a n d i n c r e a s i n g t h e c a p a c i t y o f g e n e r a t i n g
m ult idir ect ional st r engt h, w hich per m it s dir ect ing t he
ex pu lsiv e pow er( 1 4 ).
This char act er ist ic fav or s t he t r ansm ission of
elect r ic signs, per m it t ing t he diffusion of cont r act ion
st r en g t h i n sev er al d i r ect i o n s, t h r o u g h su ccessi v e
st im u li r espon sible for t h e du r at ion an d in t en sit y of
t he cont ract ion, bot h in num ber and int ensit y.
I n t h e pr esen t st u dy, t h e glu cose valu es of
t h o se w h o f a st ed a n d t h o se w h o r ecei v ed ca l o r i c
r ep l acem en t ( h on ey ) d i d n ot p r esen t a si g n i f i can t
differ en ce du r in g labor, alt h ou gh lact at e lev els w er e
significant ly higher in t he lat t er gr oup aft er ingest ion
of 14 gr am s of honey ( 44cal) . This r esult is im por t ant
for t he m at er nal per for m ance diagnosis dur ing labor
becau se t h e elev at ion of lact at e ev iden ces t h at t h e
lact at e b eh av ior, sh ow in g a sig n if ican t in f lu en ce on
t he per for m ance of t hose w ho ingest ed honey.
The concent rat ions of blood lact at e in differ ent
w o r k l o a d s a r e h i g h l y d e p e n d e n t o n t h e g l y co g e n
s t o r a g e b e c a u s e , w h e n i t i s i n a d e q u a t e , t h e
concent rat ion of lact at e dim inishes, depending on t he
w o r k l o a d . D e s p i t e t h e c o m p l e x i t y o f m e t a b o l i c
r egulat ion, t he m easur es of blood lact at e can be used
t o preview t he perform ance in t he anaer obic exer cise,
under phy siological or pat hological condit ions( 15). Alt h ou gh st u dies t h at iden t if y t h e en er get ic
n eeds du r in g labor ar e n ot k n ow n , t h e t ot al en er gy
ex pen dit u r e in 2 4 h ou r s w as t h e sam e for bot h t h e
gr oup w ho ingest ed t he calor ic r eplacem ent and t hat
w hich fast ed.
Sub- m ax im um t est s ar e useful t o det er m ine
t h e c a r d i o - r e s p i r a t o r y a p t i t u d e l e v e l i n h e a l t h y
in d iv id u als. Som e st u d ies in d icat e a h ig h er aer ob ic
ca p a ci t y i n t r a i n e d w o m e n , w h i l e o t h e r s d o n o t
dem onst r at e any significant differ ence in t he VO2m ax l e v e l s a m o n g t r a i n e d a n d n o n - t r a i n e d p r e g n a n t
w om en( 16- 17). I n t he pr esent st udy, t he t w o gr oups did not hav e previous t raining, show ing t hat , dur ing labor,
t h e car d io- r esp ir at or y cap acit y r at es p r esen t g ood
p er f or m an ce w h en com p ar ed w it h t h e con d it ion in g
cat egor ies for t he Har v ar d w om en’s healt h w at ch( 13). Fo r t h e g r o u p t h a t r e c e i v e d c a l o r i c
r e p l a c e m e n t , 1 4 g r a m s o f h o n e y ( 4 4 K c a l ) w e r e
o f f e r e d d u r i n g l a b o r a n d t h e t o t a l f i n a l e n e r g y
expendit ur e indicat ed t hat t he honey w as im m ediat ely
used, show ing a bet t er anaer obic per for m ance, w hich
w as con f ir m ed b y t h e lact at e lev els v er if ied d u r in g
t he per iod.
Ev e n t h o u g h t h e e f f o r t m a d e i n l a b o r i s
com par ed t o at hlet ic per for m ance, such as r unning a
m ar at hon for ex am ple, t her e is a lack of infor m at ion
on t he par t ur ient s’ nut r it ional needs( 8). I n t he lit erat ure con su lt ed , on ly on e r esear ch su g g est s t h at d u r in g
labor, ar ound 50 t o 100 calor ies ar e spent per hour( 18). Ther efor e, it r em ains unansw er ed w hich w ould be t he
adequat e nut r it ional diet dur ing labor, w hat quant it y
should be ingest ed and w hat t he r isk/ benefit s ar e for
t he m ot her and fet us.
Thus, t his st udy pr oposal t o offer honey dur ing
labor is j ust ified by t he propriet ies of t his food, w hich
is r ich in car bohy dr at es, poor in sucr ose and w hose
assim ilat ion does not dem and act ive par t icipat ion fr om
t he or ganism( 11).
I n v i ew o f o r i en t at i o n s b y t h e Mi n i st r y o f
Healt h( 10) t o offer sm all quant it ies of liquid during t he act iv e p h ase of lab or, w e con sid er t h at t h e calor ic
r eplacem ent obt ained by t he ingest ion of honey is a
low cost alt er nat iv e w hich t he par t ur ient w om en w ill
easily accept .
CONCLUSI ON
These st udy r esult s r ev eal t hat t he ingest ion
o f h o n e y d i d n o t ca u se a n o v e r l o a d i n m a t e r n a l
g l u co se . Th e l a ct a t e r e sp o n se i n d i ca t e d t h a t t h e
s u b s t r a t e o f f e r e d w a s w e l l u s e d . Th e c a r d i o
-r e s p i -r a t o -r y c a p a c i t y -r a t e s d e m o n s t -r a t e d “ g o o d
p e r f o r m a n ce ” f o r b o t h g r o u p s. Th e t o t a l e n e r g y
ex p en d it u r e d u r in g lab or su g g est s t h e in g est ion of
car bohydr at e exer t s a significant influence, im pr oving
m at er n al an aer obic per f or m an ce. I m m ediat ely af t er
labor, t h e gr ou p w h o fast ed pr esen t ed h igh er lev els
of lact at e, show ing t he effor t t he or ganism exer t ed t o
com pensat e for t he ener gy spent .
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