Ariani Impieri de Souza

Anemia e obesidade: um paradoxo da transição nutricional brasileira

The aim of this study was to analyze the growing prevalence of anemia and overweight/obesity as contrasting trends in Brazils nutritional transition. Twenty-eight studies published on anemia in children and childbearing-age women were selected, based on statistical representativeness, standardization of laboratory methods, and World Health Organization criteria. Overweight/obesity in adults was assessed by body mass index: 25 to 29.9kg/m2 (overweight) and > 30kg/m2 (obesity). Three surveys were compared for analysis of tendencies: 1974/1975 (36.4%), 1989 (53.5%), and 2002/2003 (51.9%) for overweight/obesity prevalence. In the most representative study on anemia among children (< 11g/dL), the prevalence increased from 22.0% (1974) to 46.9% (1995/1996). For pregnant woman (< 11g/dL), results ranged from 14.7 to 40.4%. Prevalence of anemia among children and overweight/obesity among adults showed similar tendencies over time. Recent evidence of reduction in anemia can be attributed to flour supplementation with iron and folic acid. Anemia and overweight/obesity are associated with significant changes in food intake as a substratum of the nutritional transition.

Effectiveness of contraceptive counselling of women following an abortion: a systematic review and meta-analysis

Objective To perform a systematic review of the effectiveness of contraceptive counselling in women undergoing an abortion and its impact on the acceptance and use of contraceptive methods. Methods Randomized controlled trials (RCTs) assessing women who had undergone an abortion and received contraceptive counselling at that time met the inclusion criteria. Articles published between 1997 and 2007 were selected from searches of the LILACS, SCIELO, MEDLINE, PubMed and Cochrane Library databases. Two reviewers independently assessed eligibility and the quality of the trial. The internal validity of the RCTs was evaluated by means of the Jadad scale. A meta-analysis of the three retained studies involving 694 women was performed. The Stata 9.2 SE statistical software was used, and a level of significance of 0.05 adopted. Results There were no differences between intervention and control groups, despite clinical heterogeneity. The results of the meta-analysis were not significant (OR = 1.32; CI: 0.90–1.94). Conclusion There was no evidence indicating that contraceptive counselling is effective in increasing acceptance and use of contraceptive methods after an abortion. This may not apply to developing countries, where the matter still needs to be investigated.

Anemia como problema de saúde pública: uma realidade atual

Em 1990, as Nacoes Unidas promoveram a Reuniao de Cupula de Nova Iorque, onde foram tracadas metas para o decenio vindouro, dentre as quais, a reducao de um terco na prevalencia das anemias nas mulheres em idade fertil. Porem, apesar de percentual modesto, indicios epidemiologicos apontam no sentido inverso, ou seja, indicam a crescente e grave ocorrencia de anemia em diferentes regioes do mundo, inclusive no Brasil. Ao reunir esses informes, constata-se que a anemia continua, desde a antiguidade, a ser uma das entidades nosologicas mais prevalentes e difundidas nas populacoes humanas. A partir dai surge uma serie de questionamentos ainda sem respostas em relacao as reais prevalencia e etiopatogenia do problema, ao grau de implantacao e a efetividade das medidas de controle.

Efetividade de três esquemas com sulfato ferroso para tratamento de anemia em gestantes

OBJECTIVE To evaluate the effectiveness of three regimens employing ferrous sulfate to treat pregnant women with anemia. METHODS The study was carried out at the Womens Health Center of the Pernambuco Institute of Maternal and Child Health in the city of Recife, Pernambuco, Brazil, from May 2000 to December 2001. A randomized clinical trial with blinded laboratory analysis was conducted. Iron (60 mg) was administered as 300-mg ferrous sulfate tablets. The women were allocated to three treatment groups, according to the frequency of ingesting the tablets: once a week (48 women), twice a week (53 women), and once a day (49 women). The groups were compared for the values for hemoglobin (Hb) concentration, mean corpuscular volume, and ferritin before and after the treatment. RESULTS Before the intervention, the groups were homogeneous. They had the following mean (+/- standard deviation) concentrations of hemoglobin: 10.2 +/- 0.5 g/dL for the group receiving iron once a week, 10.2 +/- 0.6 g/dL for the group receiving iron twice a week, and 10.1 +/- 0.6 g/dL for the group receiving iron once a day. The means of corpuscular volume were, respectively: 88.5 +/- 5.0 fL, 87.6 +/- 5.9 fL, and 88.7 +/- 5.1 fL. The respective medians for ferritin were 30.2 ng/mL, 37.1 ng/mL, and 52.9 ng/mL. The cure rate (Hb > 11 g/dL) was 27% in the patients treated once a week, 34% in those treated twice a week, and 47% in the women treated daily. Treatment failure (hemoglobin < 10 g/dL) was seen in 41.6%, 13.2%, and 2.0% of the patients in the respective groups. Interruption of treatment due to diarrhea or epigastric pain occurred only among the patients treated daily. CONCLUSION The regimen with iron administered daily is still the best option for treating anemia. However, treatment with ferrous sulfate administered twice a week is an alternative for patients who are unable to adhere to daily treatment.

Fatores associados ao ganho ponderal excessivo em gestantes atendidas em um serviço público de pré-natal na cidade de Recife, Pernambuco, Brasil

Este estudo teve como objetivo avaliar a evolucao do ganho ponderal excessivo durante o segundo e o terceiro trimestre da gestacao e a influencia de fatores biologicos, socio-demograficos, comportamentais, reprodutivos e morbidades associadas a este ganho. Foi realizado um estudo descritivo com dados de 240 gestantes de baixo risco obstetrico coletadas para um ensaio clinico sobre tratamento de anemia no periodo de maio de 2000 a julho de 2001. O banco de dados original continha 347 registros, porem foram excluidas 107, sendo 42 por idade menor que 18 anos e 65 por falta de registro dos pesos das gestantes nos prontuarios ate o final do pre-natal. Foi observado elevado percentual de ganho de peso semanal excessivo em todas as categorias de peso inicial, embora, no segundo trimestre, o ganho de peso tenha sido significativamente maior naquelas que ja iniciaram a gestacao com sobrepeso/obesidade. No terceiro trimestre, as variaveis que apresentaram associacao significante com o ganho de peso semanal excessivo foram a escolaridade materna e a situacao marital.

Choices on contraceptive methods in post-abortion family planning clinic in the northeast Brazil

BackgroundIn Brazil, a Ministry of Health report revealed women who underwent an abortion were predominantly in the use of contraceptive methods, but mentioned inconsistent or erroneously contraceptive use. Promoting the use of contraceptive methods to prevent unwanted pregnancies is one of the most effective strategies to reduce abortion rates and maternal morbidity and mortality. Therefore, providing post-abortion family planning services that include structured contraceptive counseling with free and easy access to contraceptive methods can be suitable. So the objective of this study is to determine the acceptance and selection of contraceptive methods followed by a post-abortion family planning counseling.MethodsA cross-sectional study was carried out from July to October 2008, enrolling 150 low income women to receive post-abortion care at a family planning clinic in a public hospital located in Recife, Brazil. The subjects were invited to take part of the study before receiving hospital leave from five different public maternities. An appointment was made for them at a family planning clinic at IMIP from the 8th to the 15th day after they had undergone an abortion. Every woman received information on contraceptive methods, side effects and fertility. Counseling was individualized and addressed them about feelings, expectations and motivations regarding contraception as well as pregnancy intention.ResultsOf all women enrolled in this study, 97.4% accepted at least one contraceptive method. Most of them (73.4%) had no previous abortion history. Forty of the women who had undergone a previous abortion, 47.5% reported undergoing unsafe abortion. Slightly more than half of the pregnancies (52%) were unwanted. All women had knowledge of the use of condoms, oral contraceptives and injectables. The most chosen method was injectables, followed by oral contraceptives and condoms. Only one woman chose an intrauterine device.ConclusionThe acceptance rate of post-abortion contraceptive methods was greater and the most chosen method was the best-known one. Implementing a specialized family planning post abortion service may promote an acceptance, regardless of the chosen method. Most important is they do receive contraception if they do not wish for an immediate pregnancy.

Adherence and side effects of three ferrous sulfate treatment regimens on anemic pregnant women in clinical trials

The objective of this study was to analyze adherence and side effects of three iron supplement regimens (ferrous sulfate) on anemic pregnant women. The clinical trial involved 150 women between the 16th and 20th gestational weeks, at low obstetric risk and with hemoglobin concentration of between 8.0 and 11.0 g/dL. Treatment was provided by ferrous sulfate with 60 mg of elemental iron during 16 (+/- 1) weeks, in three regimens: single tablet a week (n = 48); single tablet twice a week (n = 53) or single tablet a day (n = 49). The outcomes were adherence, assessed through interviews and by counting tablets, and side effects, according to patient information. The adherence showed a declining trend (92%, 83% and 71%; p = 0.010) and the side effects revealed a growing trend (40%, 45% and 71%; p = 0.002) as the dosage increased. Diarrhea and epigastric pain were significantly associated with the dose administered (p = 0.002). These results suggest that in anemic pregnant women, complaints are directly proportional and the compliance is inversely proportional to the amount of medicinal iron.O objetivo deste estudo foi analisar a adesao e os efeitos colaterais de tres esquemas de suplementacao com sulfato ferroso em gestantes anemicas. O ensaio clinico incluiu 150 mulheres entre a 16a e 20a semanas de gestacao, de baixo risco obstetrico e com concentracao de hemoglobina entre 8,0 e 11,0g/dL. A intervencao foi realizada com 60mg de ferro elementar, durante 16 (±1) semanas, em tres esquemas: uma dragea semanal (n = 48); uma dragea duas vezes por semana (n = 53) ou uma dragea diariamente (n = 49). Os desfechos foram adesao, verificada por entrevista e contagem das drageas, e efeitos colaterais auto-relatados pelas pacientes. A adesao apresentou tendencia declinante (92%, 83% e 71%; p = 0,010) e os efeitos colaterais, ascendente (40%, 45% e 71%; p = 0,002) com o aumento da dose prescrita. Diarreia e dor epigastrica estiveram significativamente associadas a dose administrada (p = 0,002). Os resultados sugerem que em gestantes anemicas as queixas e a adesao ao tratamento com sulfato ferroso sao, respectivamente, direta e inversamente proporcionais a quantidade do ferro medicamentoso.

Do perineal exercises during pregnancy prevent the development of urinary incontinence? A systematic review

Objectives:  The aim of the current article was to conduct a systematic review of the performance of perineal exercises during pregnancy and their utility in the prevention of urinary incontinence.

Effects of folic acid fortification on the prevalence of neural tube defects

OBJETIVO:Analizar el efecto de alimentos fortificados con acido folico en la prevalencia de defectos del cierre del tubo neural entre nacidos vivos. METODOS: Estudio longitudinal de nacidos vivos del municipio de Recife (Noreste de Brasil), entre 2000 y 2006. Los datos pesquisados fueron obtenidos del Sistema Nacional de Informaciones de Nacidos Vivos. Los defectos del cierre del tubo neural fueron definidos de acuerdo con el Codigos Internacional de Enfermedades- 10a Revision: anencefalia, encefalocele y espina bifida. Se compararon las prevalencias en los periodos anterior (2000 - 2004) y posterior (2005-2006) al periodo obligatorio de fortificacion. Se analizo la tendencia temporal de las prevalencias trimestrales de defectos del cierre del tubo neural por las pruebas de Mann-Kendall y Sens Slope. RESULTADOS: No se identifico tendencia de reduccion en la ocurrencia del hecho (Teste de Mann-Kendall); p= 0,270; Sens Slope = - 0,008) en el periodo estudiado. No hubo diferencia estadisticamente significativa entre las prevalencias de defectos de cierre del tubo neural en los periodos anterior y posterior a la fortificacion de los alimentos con acido folico de acuerdo con las caracteristicas maternas. CONCLUSIONES: A pesar de que no haya sido observada reduccion de los defectos de cierre del tubo neural posterior al periodo obligatorio de fortificacion de alimentos con acido folico, los resultados encontrados no permiten descartar el beneficio del mismo en la prevencion de esta malformacion. Son necesarios estudios evaluando mayor periodo y considerando el nivel de consumo de los productos fortificados por las mujeres en edad fertil.OBJECTIVE To analyze the effect of folic acid-fortified foods on the prevalence of neural tube defects in live newborns. METHODS Longitudinal study with newborns from the city of Recife, Northeastern Brazil, between 2000 and 2006. Data analyzed were obtained from the Sistema Nacional de Informações de Nascidos Vivos (National Information System on Live Births). Neural tube defects were defined in accordance with the International Classification of Diseases, 10th revision (ICD-10): anencephaly, encephalocele, and spina bifida. Prevalences from the periods before (2000-2004) and after (2005-2006) the mandatory fortification period were compared. Time trend of three-month prevalences of neural tube defects were analyzed using Mann-Kendall test and Sens Slope estimator. RESULTS Tendency towards reduction in the occurrence of outcome (Mann-Kendall test; p= 0.270; Sens Slope estimator =-0.008) was not identified in the period studied. The difference between prevalences of neural tube defects in the periods before and after food fortification with folic acid was not statistically significant, according to maternal characteristics. CONCLUSIONS Even though reduction in neural tube defects after the period of mandatory food fortification with folic acid was not observed, results found do not enable its benefit to prevent malformations to be ruled out. Studies assessing longer periods and considering the level of consumption of fortified products by women of fertile age are necessary.

Efeito da fortificação alimentar com ácido fólico na prevalência de defeitos do tubo neural

OBJETIVO:Analizar el efecto de alimentos fortificados con acido folico en la prevalencia de defectos del cierre del tubo neural entre nacidos vivos. METODOS: Estudio longitudinal de nacidos vivos del municipio de Recife (Noreste de Brasil), entre 2000 y 2006. Los datos pesquisados fueron obtenidos del Sistema Nacional de Informaciones de Nacidos Vivos. Los defectos del cierre del tubo neural fueron definidos de acuerdo con el Codigos Internacional de Enfermedades- 10a Revision: anencefalia, encefalocele y espina bifida. Se compararon las prevalencias en los periodos anterior (2000 - 2004) y posterior (2005-2006) al periodo obligatorio de fortificacion. Se analizo la tendencia temporal de las prevalencias trimestrales de defectos del cierre del tubo neural por las pruebas de Mann-Kendall y Sens Slope. RESULTADOS: No se identifico tendencia de reduccion en la ocurrencia del hecho (Teste de Mann-Kendall); p= 0,270; Sens Slope = - 0,008) en el periodo estudiado. No hubo diferencia estadisticamente significativa entre las prevalencias de defectos de cierre del tubo neural en los periodos anterior y posterior a la fortificacion de los alimentos con acido folico de acuerdo con las caracteristicas maternas. CONCLUSIONES: A pesar de que no haya sido observada reduccion de los defectos de cierre del tubo neural posterior al periodo obligatorio de fortificacion de alimentos con acido folico, los resultados encontrados no permiten descartar el beneficio del mismo en la prevencion de esta malformacion. Son necesarios estudios evaluando mayor periodo y considerando el nivel de consumo de los productos fortificados por las mujeres en edad fertil.OBJECTIVE To analyze the effect of folic acid-fortified foods on the prevalence of neural tube defects in live newborns. METHODS Longitudinal study with newborns from the city of Recife, Northeastern Brazil, between 2000 and 2006. Data analyzed were obtained from the Sistema Nacional de Informações de Nascidos Vivos (National Information System on Live Births). Neural tube defects were defined in accordance with the International Classification of Diseases, 10th revision (ICD-10): anencephaly, encephalocele, and spina bifida. Prevalences from the periods before (2000-2004) and after (2005-2006) the mandatory fortification period were compared. Time trend of three-month prevalences of neural tube defects were analyzed using Mann-Kendall test and Sens Slope estimator. RESULTS Tendency towards reduction in the occurrence of outcome (Mann-Kendall test; p= 0.270; Sens Slope estimator =-0.008) was not identified in the period studied. The difference between prevalences of neural tube defects in the periods before and after food fortification with folic acid was not statistically significant, according to maternal characteristics. CONCLUSIONS Even though reduction in neural tube defects after the period of mandatory food fortification with folic acid was not observed, results found do not enable its benefit to prevent malformations to be ruled out. Studies assessing longer periods and considering the level of consumption of fortified products by women of fertile age are necessary.