Associação entre a Assistência Pré-Natal e o Ganho de Peso Gestacional: Estudo Seccional em uma Área de Baixa Renda do Rio de Janeiro

Autores

  • Débora Souza Gigante Departamento de Nutrição Social e Aplicada do Instituto de Nutrição Josué de Castro da Universidade Federal do Rio de Janeiro
  • Amanda Rodrigues Amorim Adegboye School of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Coventry University, Priory Street, Coventry, CV1 5FB, UK https://orcid.org/0000-0003-2780-0350
  • Elisa Maria de Aquino Lacerda Department of Nutrition and Dietetics. Institute of Nutrition Josue de Castro (INJC), Federal University of Rio de Janeiro, Posgraduate Program of Nutrition/INJC. https://orcid.org/0000-0002-1830-4278
  • Cláudia Saunders Research Group on Maternal and Child Health, Departament of Nutrition and Dietetics. Institute of Nutrition Josue de Castro (INJC), Federal University of Rio de Janeiro, Posgraduate Program of Nutrition/INJC. https://orcid.org/0000-0001-8815-6736
  • Patrícia Carvalho Padilha Research Group on Maternal and Child Health, Departament of Nutrition and Dietetics. Institute of Nutrition Josue de Castro (INJC), Federal University of Rio de Janeiro, Posgraduate Program of Nutrition/INJC.
  • Maria Beatriz Trindade de Castro Department of Social and Applied Nutrition, Institute of Nutrition Josue de Castro (INJC), Federal University of Rio de Janeiro, Posgraduate Program of Nutrition/INJC https://orcid.org/0000-0001-6618-4007

DOI:

https://doi.org/10.12957/demetra.2021.58362

Palavras-chave:

Estado Nutricional. Gravidez. Saúde Pública. Ganho de Peso na Gestação. Cuidado Pré-Natal.

Resumo

Objetivo: Verificar a associação entre a adequação da assistência pré-natal e o ganho de peso gestacional (GPG) em puérperas brasileiras de baixa renda. Métodos: Estudo transversal no município de Mesquita-RJ, incluindo 281 mulheres no pós-parto imediato. O GPG foi classificado como adequado, insuficiente e excessivo de acordo com as recomendações do Institute of Medicine (IOM). O número de consultas do pré-natal foi categorizado (1: nenhuma consulta; 2: 1-3 consultas; 3: 4-6 consultas; 4: 7 ou mais consultas) e o início do pré-natal, segundo as semanas gestacionais (SG), foi utilizado como variável contínua. A assistência pré-natal (AP) avaliou as duas dimensões agrupadas do Índice de Kotelchuck: adequado (adequado + mais adequado) ou inadequado (intermediário e inadequado). Modelos de regressão logística multinomial foram utilizados para estimar as associações entre assistência pré-natal inadequada e GPG. Resultados: AP foi iniciada em média com 12,6 (± 6,9) SG; 8,2% das mulheres (n = 23) fizeram ≤ 4 consultas de pré-natal e 38,4% (n = 108) foram classificadas com AP inadequada. Em média, o GPG foi de 12,9 kg (± 6,2) e 36,5%, 31,0% e 32,5% das mulheres apresentaram GPG adequado, insuficiente e excessivo, respectivamente. Após o ajuste, a inadequação da AP (OR = 2,01; IC 95% = 1,03-3,90) foi associada a uma maior probabilidade de GPG abaixo das recomendações do IOM. Conclusão: Observou-se uma associação significativa entre a inadequação da assistência pré-natal e o GPG insuficiente, o que reforça a relevância da adequada AP para monitorar o adequado GPG e intervir precocemente na gestação.

Referências

References

(1) Brasil. Pré-natal e puerpério, atenção qualificada e humanizada Série A. Normas e Manuais Técnicos - Série Direitos Sexuais e Direitos Reprodutivos (2006) - Caderno nº 5. Brasília.

(2) Mamun AA, Callaway LK, O'Callaghan MJ et al. Associations of maternal pre-pregnancy obesity and excess pregnancy weight gains with adverse pregnancy outcomes and length of hospital stay. BMC Pregnancy Childbirth (2011); 11, 2-9.

(3) Melo ASO, Assunção PL, Gondim SSR et al. Maternal nutritional status, gestational weight gain and birth weight. Rev Bras Epidemiol (2007); 10, 249-57.

(4) Chuang CH, Stengel MR, Hwang SW et al. Behaviours of overweight and obese women during pregnancy who achieve and exceed recommended gestational weight gain. Obes Res Clin Pract (2014); 8, 577-83.

(5) Padilha PC, Barros DC, Campos AB et al. Performance of an anthropometric assessment method as a predictor of low birthweight and being small for gestational age. J Hum Nutr Diet (2015); 28, 292-9.

(6) Konno SC, Benicio D'Aquino MH, Barros AJ. Factors associated to the evolution of gestational weight of pregnant women: a multilevel analysis. Rev Saúde Pública (2007); 41, 995-1002. PubMed PMID: 18066469.

(7) Stulbach TE, Benício MHD, Andreazza R et al. Determinants of excessive weight gain during pregnancy in a public low risk antenatal care service. Rev Bras Epidemiol (2007); 10, 99-108.

(8) Institute of Medicine. Weight Gain during Pregnancy: Reexamining the Guidelines. National Academies Press, Washington, DC: Committee to Reexamine IOM Pregnancy Weight Guidelines (2009).

(9) Wilkinson S, Beckmann M, Donaldson E et al. Implementation of gestational weight gain guidelines - what’s more effective for ensuring weight recording in pregnancy? BMC Pregnancy Childbirth (2019); 19, 19.

(10) Castro MBT, Kac G, Sichieri R. Determinantes nutricionais e sócio-demográficos da variação de peso no pós-parto: uma revisão da literatura. Rev Bras Saúde Matern Infant (2009), 9, 125-37.

(11) Campos CAS, Malta MB, Neves PAR et al. Gestational weight gain, nutritional status and blood pressure in pregnant women. Rev Saúde Pública (2019); 53:57.

(12) World Health Organization. WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience. Geneva, Switzerland: World Health Organization; 2016.

(13) Kotelchuck M. An evaluation of the Kessner Adequacy of Prenatal Care Index and a proposed Adequacy of Prenatal Care Utilization Index. Am J Public Health (1994); 84, 1414-20.

(14) Hunt KJ, Alanis MC, Johnson ER et al. Maternal pre-pregnancy weight and gestational weight gain and their association with birthweight with a focus on racial differences. Matern Child Health J (2013); 17, 85-94.

(15) Popa AD, Popescu RM, Botnariu GE. Adequate weight gain in pregnancy: an analysis of its determinants in a cross-sectional study. Srp Arh Celok Lek (2014); 142, 695-702.

(16) Yeo S, Crandell JL, Jones-Vessey K. Adequacy of Prenatal Care and Gestational

Weight Gain. J Womens Health (Larchmt) (2016); 25, 117-23.

(17) Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Cadernos de Atenção Básica, n° 32. Atenção ao pré-natal de baixo risco. Brasília; 2012

(18) Viellas EF, Domingues RM, Dias MA et al. Prenatal care in Brazil. Cad Saúde Pública (2014); 30, S1-15.

(19) Mario DN, Rigo L, Boclin KLS et al. Quality of Prenatal Care in Brazil: National Health Research 2013. Cien Saude Colet (2019); 24,1223-1232.

(20) Cunha AC, Lacerda JT, Alcauza MTR et al. Evaluation of prenatal care in Primary Health Care in Brazil. Rev Bras Saúde Mater Infant (2019); 19,447-458.

(21) Tsunechiro MA, Lima MOP, Bonadio IC et al. Prenatal care assessment according to the Prenatal and Birth Humanization Program. Rev Bras Saúde Mater Infant (2018); 18, 771-780.

(22) Lohman TG, Roche AF, Martorell R. Anthropometric standardization reference manual (1988). Champaign, IL: Human Kinetics Books.

(23) Oliveira AF, Gadelha AM, Leal MC et al. Study of validity in self-reported weight and height among pregnant women treated at municipal maternity hospitals in Rio de Janeiro, Brazil. Cad Saúde Pública (2004); 20, S92-100.

(24) Peixoto MR, Benício MH, Jardim PC. Validity of self-reported weight and height: the Goiânia study, Brazil. Rev Saúde Pública (2006); 40, 1065-72.

(25) Victora CG, Huttly SR, Fuchs SC et al. The role of conceptual frameworks in epidemiological analysis: a hierarchical approach. Int J Epidemiol (1997); 26, 224-7.

(26) Olinto MTA, Victora CG, Barros FC et al. Determinants of Malnutrition in a Low-Income Population: Hierarchical Analytical Model. Cad Saúde Publ (1993); 9,14-27.

(27) Statacorp. Stata statistical software: release 12 (2011). College Station (TX): StataCorp LP.

(28) Popa AD, Oleniuc M, Graur M. Prenatal care and weight gain during pregnancy. Rev Med Chir Soc Med Nat Iasi (2011); 115,1149-54.

(29) Stotland N, Tsoh JY, Gerbert B. Prenatal weight gain: who is counseled? J Womens Health (2012); 21, 695-701.

(30) Cohen TR, Koski KG. Limiting excess weight gain in healthy pregnant women: importance of energy intakes, physical activity, and adherence to gestational weight gain guidelines. J Pregnancy (2013); 2013787032.

(31) Fraga AC, Theme Filha MM. Factors associated with gestational weight gain in pregnant women in Rio de Janeiro, Brazil, 2008. Cad Saúde Pública (2014); 30, 633-44.

(32) Drehmer M, Camey S, Schmidt MI et al. Socioeconomic, demographic and nutritional factors associated with maternal weight gain in general practices in Southern Brazil. Cad Saúde Pública (2010); 26, 1024-34.

(33) Yan J. The earlier and the more, the healthier? The effects of prenatal care utilization on maternal health and health behaviors. Health Economics (2017); 26, 1001-1018.

(34) Krukowski RA, Bursac Z, McGehee MA et al. Exploring potential health disparities in excessive gestational weight gain. J Women’s Health (2013); 22, 494-499.

(35) Fealy SM, Taylor RM, Foureur M et al. Weighing as a stand-alone intervention does not reduce excessive gestational weight gain compared to routine antenatal care: a systematic review and meta-analysis of randomised controlled trials. BMC Pregnancy and Childbirth (2017); 17, 36.

(36) Siega-Riz AM, Bodnar LM, Stotland NE et al. The current understanding of gestational weight gain among women with obesity and the need for future research. NAM Perspectives (2020). Discussion Paper, National Academy of Medicine, Washington, DC.

(37) Cheney K, Berkemeier S, Gordon A et al. Prevalence and predictors of early gestational weight gain associated with obesity risk in a diverse Australian antenatal population: a cross-sectional study. BMC Pregnancy and Childbirth (2017); 17, 296.

(38) Godoy AC, Nascimento SL, Surita FG. A systematic review and meta-analysis of gestational weight gain recommendations and related outcomes in Brazil. Clinics (2015); 70, 758-764.

(39) Magalhães EIS, Maia DS, Bonfim CSA et al. Prevalência e fatores associados ao ganho de peso gestacional excessivo em unidades de saúde do sudoeste da Bahia. Rev Bras Epidemiol (2015); 18, 858-69.

(40) Domingues RMSM, Hartz ZMA, Dias MAB et al. Avaliação da adequação da assistência pré-natal na rede SUS do Município do Rio de Janeiro, Brasil. Cad Saúde Publica (2012); 28, 425-37.

(41) Traldi MC, Galvão P, Fonseca MRCC. Prenatal care evaluation in pregnant women in the region of Jundiaí-SP, Brazil: Kotelchuck’s index. Rev Saúde (2014); 8.

(42) Leal MC, Gama SGN, Ratto KMN et al. Use of the modified Kotelchuck index in the evaluation of prenatal care and its relationship to maternal characteristics and birth weight in Rio de Janeiro, Brazil. Cad Saúde Pública (2004); 20, S63-S72.

(43) Tayebi T, Zahrani ST, Mohammadpour R. Relationship between adequacy of prenatal care utilization index and pregnancy outcomes. Iran J Nurs Midwifery Res (2013); 18, 360–366.

(44) Shin D, Song WO. Influence of the adequacy of the prenatal care utilization Index on Small-for-gestational-age infants and preterm births in the United States. J Clin Med (2019); 8, 838.

(45) Davis-Moss RR, Hofferth SL. Inadequate gestational weight gain and malnutritionrelated

causes of infant death. J Pregnancy Reprod (2018); 2, 1-5.

(46) Bouvier D, Forest JC, Dion-Buteau E et al. Association of maternal weight and gestational weight gain with maternal and neonate outcomes: a prospective cohort study. J Clin Med (2019); 8, 2074.

(47) Fonseca CRB, Strufaldi MWL, Carvalho LR et al. Adequacy of antenatal care and its relationship with low birth weight in Botucatu, São Paulo, Brazil: a case-control study. BMC Pregnancy Childbirth (2014); 14, 255.

(48) Vítolo MR, Bueno MS, Gama CM. Impact of a dietary counseling program on the gain weight speed of pregnant women attended in a primary care service. Rev Bras Ginecol Obstet (2011); 33, 58-9.

(49) Rebelo F, Castro MBT, Dutra CL et al. Factors associated with postpartum weight retention in a cohort of women, 2005–2007. Rev Bras Saúde Matern Infant (2010); 10, 219-27.

(50) Johansson K, Linné Y, Rössner S et al. Maternal predictors of birthweight: The importance of weight gain during pregnancy. Obes Res Clin Pract (2007); 1, 223-90.

(51) Nast M, Oliveira A, Rauber F et al. Excessive gestational weight gain is risk factor for overweight among women. Rev Bras Ginecol Obstet (2013); 35, 536-40.

(52) Andreto LM, Souza AI, Figueiroa JN et al. Factors associated with excessive gestational weight gain among patients in prenatal care at a public hospital in Recife, Pernambuco, Brazil. Cad Saúde Pública (2006); 22, 2401-9.

(53) Heerman WJ, Bian A, Shintani A et al. Interaction between maternal pre-pregnancy body mass index and gestational weight gain shapes infant growth. Acad Pediatr (2014); 14, 463-70.

(54) Padilha PC, Saunders C, Machado RCM et al. Associação entre o estado nutricional pré-gestacional e a predição do risco de intercorrências gestacionais. Rev Bra Ginecol e Obstet (2007); 29, 511-518.

(55) Rodrigues PL, Oliveira LC, Brito AS. Determinant factors of insufficient and excessive gestational weight gain and maternal–child adverse outcomes. Nutrition (2010); 26, 617–623.

(56) Zozzaro-smith PE, Bacak S, Conway C et al. Association between obesity during pregnancy and the adequacy of prenatal care. Matern child health J (2015); 20, 158-63.

Bannon AL, Waring ME, Leung K et al. Comparison of Self-reported and Measured Pre-pregnancy Weight: Implications for Gestational Weight Gain Counseling. Matern Child Health J (2017); 21, 1469–78.

Holland E, Moore Simas TA, Doyle Curiale DK et al. Self-reported pre-pregnancy weight versus weight measured at first prenatal visit: effects on categorization of pre-pregnancy body mass index. Matern Child Health J (2013); 17, 1872-78.

(59) Scholl TO, Hediger ML, Schall JI et al. Gestational weight gain, pregnancy outcome, and postpartum weight retention. Obstet Gynecol (1995); 86, 423-7.

(60) Soliman FES. Satisfaction of rural pregnant women as quality indicator of provided antenatal care. IJSRP. 2015, 5, 1-9.

(62) Olson CM, Strawderman MS, Reed RG. Efficacy of an intervention to prevent excessive gestational weight gain. Am J Obstet Gynecol. 2004 Aug;191(2):530-6.

(62) Vieira SM, Bock LF, Zocche DA et al. Percepção das puérperas sobre a assistência prestada pela equipe de saúde no pré-natal. Texto Contexto Enferm (2011); 20, 255-62.

Publicado

2021-07-28

Como Citar

Gigante, D. S., Adegboye, A. R. A., Lacerda, E. M. de A., Saunders, C., Padilha, P. C., & Castro, M. B. T. de. (2021). Associação entre a Assistência Pré-Natal e o Ganho de Peso Gestacional: Estudo Seccional em uma Área de Baixa Renda do Rio de Janeiro. DEMETRA: Alimentação, Nutrição & Saúde, 16, e58362. https://doi.org/10.12957/demetra.2021.58362

Edição

Seção

Alimentação e Nutrição em Saúde Coletiva