Beatriz Della Líbera

[Pica: epidemiology and association with pregnancy complications].

PURPOSE to verify the occurrence ratio of pica in pregnant women and its impact on the mother and newborn health. METHODS prospective study with 227 adult pregnant women and their newborns treated at the Maternity School of Universidade Federal do Rio de Janeiro, between 2005 and 2006. Pica has been considered as the ingestion of inedible substances or atypical food combinations. The data was collected was done by medical chart review and interview. RESULTS Pica was referred to by 14.4% of the women, 42.1% of whom practiced it daily. The onset occurred in the second gestational trimester in 46.7% of the cases, and, in the third trimester, in 30% of them. Among the alleged reasons, 65% of the women were unable to give them, 15% declared relief of nausea and heartburn and 10% reported reduced stress and anxiety. The practice in the previous gestation/puerperium was referred to by 15% of the women. Pica was not associated with the maternal anthropometric condition, the skin color, the marital status, the maternal schooling and the presence of parasitosis. There was no difference between the average of the total family income and the number of gestations for the women who did or did not have pica. Pica was associated with gestational anemia (p<0.009) and gestational intercurrences (OR=3.5; CI95%=1.6-7.9). As for the baby, pica did not interfere in the health parameters at birth: weight, gestational age and intercurrences. CONCLUSIONS pica must be investigated at prenatal assistance and recognized as a risk factor for the mothers health.

Avaliação da assistência pré-natal na perspectiva de puérperas e profissionais de saúde

The aim of this study was to evaluate the prenatal assistance in a public maternity hospital in the point of view of puerperas and health care professionals. Nineteen puerperas and six health professionals took part in the study. The puerperas answered a semi-structured interview and the health professionals took part in a focus group. The discourse analysis was based on in-depth hermeneutics. The main results pointed out that users showed a deep appreciation for the health professionals. Concerning the professionals view, pregnant women had a wrong knowledge of health during pregnancy. As regards the nutrition appointments, puerperas pointed out they had room for dialogue, support and encouragement. In conclusion, prenatal health education should consider that each woman is a unique individual with her own background. Bonding is of paramount importance for pregnant women to get involved with health-related issues.

The performance of various anthropometric assessment methods for predicting low birth weight in pregnant women

OBJECTIVES: to assess the performance of various anthropometric methods for the evaulation of the nutritional status of pregnant women as a means of predicting low birth weight (LBW). METHODS: a descriptive cross-cutting study carried out among 433 pregnant women (>20 years) attending a Public Maternity Hospital in Rio de Janeiro, Brazil. The adequacy of the weight gain at the end of the pregnancy was evaluated in accordance with the proposals of the Institute of Medicine and the Brazilian Ministry of Health. The sensitivity, specificity and accuracy of the adequacy of weight gain at the end of the pregnancy or nutritional state of mother as a predictor of low birth weight were calculated. RESULTS: the sensitivity of the various methods varied from 63.1% to 68.4% and the specificity from 71.2% to 75.1%. The adapted Institute of Medicine proposal drawn up by the Brazilian Ministry of Health, according to the classification of the pre-delivery nutritional status of the mother according to the World Health Organization cutoff points showed itself to be the most accurate (74.5%), this being the most adequate method for nutritional triage for reason of its association with low birth weight (OR=4.10; 95%CI=1.53-10.92). CONCLUSIONS: the best proposals for this population are those of the Institute of Medicine and the Brazilian Ministry of Health. Further studies aiming to ascertain the most appropriate methods of anthropometric evaluation for different populations should be encouraged.

Anthropometric assessment of nutritional status in Brazilian pregnant women

Se reviso la literatura disponible publicada entre 1957 y 2007 sobre la evaluacion antropometrica de embarazadas y se analizaron criticamente las metodologias recomendadas. Las mediciones antropometricas constituyen el metodo mas frecuentemente empleado debido a su reconocida utilidad para prevenir la morbimortalidad perinatal, predecir la salud del nino y promover la salud de la madre. Ha habido un intenso debate sobre el aumento optimo de peso durante la gestacion, que ha llevado a cambiar las recomendaciones nutricionales. Hasta la decada de 1960 se sugeria limitar el aumento de peso gestacional como una forma de evitar un resultado obstetrico desfavorable. Se reconoce que la metodologia recomendada por el Instituto de Medicina (1990/1992) es la mas aceptada en todo el mundo y ha servido de estandar de referencia en muchos estudios, sin embargo, tambien se presentan otros metodos (que utilizan modelos graficos e indicadores basados en el indice de masa corporal y la tasa peso-altura gestacionales). Para contribuir a la salud materno-infantil se necesitan estudios que validen los indicadores de alteraciones nutricionales durante el em barazo y que tengan elevados valores de sensibilidad y es pecificidad con respecto a los desenlaces obstetricos inde seables, y determinar un estandar universal del aumento de peso durante la gestacion.

The performance of various anthropometric assessment methods for predicting low birth weight in adolescent pregnant women

OBJECTIVE To evaluate the performance of various anthropometric evaluation methods for adolescent pregnant women in the prediction of birth weight. METHODS It is a cross-sectional study including 826 adolescent pregnant women. In the pre-pregnancy body mass index (BMI) classification, the recommendations of the World Health Organization were compared with that of the Brazilian Ministry of Health and the Institute of Medicine (IOM) of 1992 and 2006. The gestational weight gain adequacy was evaluated according to the classification of IOM of 1992, of 2006 and of the Brazilian Ministry of Health. The newborns were classified as low birth weight (LBW) or macrosomic. Multinomial logistic regression was used for statistical analysis and sensibility, specificity, accuracy, positive and negative predictive values were calculated. RESULTS The evaluation, according to the Brazilian Ministry of Health, showed the best prediction for LBW among pregnant women with low weight gain (specificity = 69.5%). The evaluation according to the IOM of 1992 showed the best prediction for macrosomia among pregnant women with high weight gain (specificity = 50.0%). The adequacy of weight gain according to the IOM of 1992 classification showed the best prediction for LBW (OR = 3.84; 95%CI 2.19 - 6.74), followed by the method of the Brazilian Ministry of Health (OR = 2.88, 95%CI 1.73 - 4.79), among pregnant women with low weight gain. CONCLUSION It is recommended the adoption of the Brazilian Ministry of Health proposal, associated with BMI cut-offs specific for adolescents as an anthropometric assessment method for adolescent pregnant women.

Vitamin A liver store: a case–control study

The present study aims to assess the vitamin A liver store in individuals who died of several causes and to compare them with those who died of violent causes. A case–control study was performed with 60 individuals, where 30 died of violent causes (control) and 30 of other causes (cardiovascular diseases, infections, other chronic degenerative diseases, several causes). According to the cause of death, the mean retinol from liver stores was 281.5±63.50 mg/g for individuals who died of violent causes—a significantly higher amount (P<0.05) than those observed in the other group (105.4±87.54 mg/g by cardiovascular diseases, 88.1±78.03 mg/g by infections, 162.4±119.19 mg/g by other chronic degenerative diseases and 205.5±126.63 mg/g by several causes). The highest prevalence of low vitamin A was observed in individuals who died of infections and cardiovascular diseases, which emphasizes the role of vitamin A in these pathological processes.

The symbolic dimension of prenatal nutrition care in diabetes Mellitus

1 Universidade Federal do Rio de Janeiro, Maternidade Escola. Rio de Janeiro, RJ, Brasil. 2 Universidade Federal do Rio de Janeiro, Instituto de Nutrição Josué de Castro, Programa de Pós-Graduação em Nutrição. Av. Carlos Chagas Filho, 373, Edifício do Centro de Ciências da Saúde, Bloco J, Cidade Universitária, 21941-902, Rio de Janeiro, RJ, Brasil. Correspondência para/Correspondence to: MMAS SANTOS. E-mail: <marta@nutrição.ufrj.br>. 3 Nutricionista. Rio de Janeiro, RJ, Brasil.

Prenatal Nutritional Care Improved Perinatal Outcome of Pregnant Women in the Context of Primary Health Care

The aim of the study was to assess the impact of a prenatal nutritional care programme on perinatal outcome in the context of primary health care. That’s a non-randomised controlled clinical trial developed in a care unit in Rio de Janeiro, Brazil. 284 pregnant women were allocated into one of two groups: an intervention group (IG; n = 122), comprising pregnant women who received the intervention of nutritional care through collective consultations with a nutritionist, and a control group (CG, n = 162) consisting of pregnant women who did not receive the intervention. There was a higher proportion of pregnancy complications (p=0.000) and abnormal total gestational weight gain (p=0.031) in the CG. In the final model, it was found that belonging to the CG (adjusted OR=4.721; CI 95%=1.009-22.090) and living with four or more people in the household (adjusted OR=2.692; CI 95%=1.021-7.101) were predictors of pregnancy complications, while belonging to the CG (adjusted OR=2.354; CI 95%=1.063-5.213) and starting prenatal care after 16 weeks (adjusted OR =8.509; CI 95%=1.023-70.784) were determinants of abnormal pregnancy weight gain. The findings reinforce that the prenatal nutritional care programme contributed to improving the health of pregnant women.