Denise Cavalcante de Barros

O consumo alimentar de gestantes adolescentes no Município do Rio de Janeiro

The increase in teenage pregnancy has been viewed with concern by public health experts. Food consumption to help maintain high nutrient demands has been identified as one of the most relevant components. This study aims to present the habitual consumption of food and energy-specific nutrients by pregnant adolescents. A total of 1,180 adolescent mothers were interviewed in maternity hospitals in the City of Rio de Janeiro, and a simplified questionnaire on semi-quantitative frequency of food consumption was applied. Lower consumption of fruit juice, vegetables, and fruits was observed among adolescent mothers over 15. Adolescent mothers classified in the lowest quartile of consumption lack the minimum recommended consumption of energy and nutrients. An inverse association was found between the number of household members and energy and nutrient consumption. Adolescent mothers who received dietary information and changed their eating habits during pregnancy showed better results concerning the consumption of energy and nutrients. Prenatal care was a key factor for improving the results of pregnancy, emphasizing the importance of providing dietary information.

Estado nutricional pré-gestacional, ganho de peso materno, condições da assistência pré-natal e desfechos perinatais adversos entre puérperas adolescentes

OBJETIVO: Identificar associacao entre estado nutricional pre-gestacional, ganho ponderal materno e condicoes do pre-natal com os desfechos prematuridade e baixo peso ao nascer (BPN) em filhos de maes adolescentes. METODOS: Estudo transversal com 542 pares de puerperas adolescentes e conceptos atendidos em uma maternidade publica do municipio do Rio de Janeiro (RJ). Os dados foram coletados em prontuarios. Para verificar a associacao entre as variaveis independentes e os desfechos estudados, foram estimados a odds ratio (OR) e o intervalo de confianca (IC) de 95%. RESULTADOS: Quanto ao estado nutricional pre-gestacional das adolescentes, 87% apresentavam eutrofia, 1% baixo peso, 10% sobrepeso e 2% obesidade. A inadequacao do ganho de peso gestacional total (72%) superou a adequacao (28%). O peso ao nascer foi favorecido com maior ganho de peso gestacional e reduzido com inicio tardio do pre-natal (PN). A comparacao entre os grupos de conceptos com baixo peso e com peso adequado ao nascer revelou diferencas significativas entre as medias das variaveis: intervalo entre a ultima gestacao e a atual (p = 0,022); peso pre-gestacional (p = 0,018); indice de massa corporal pre-gestacional (p < 0,001) e ganho de peso gestacional total (p = 0,047). As chances de BPN (OR 2,70; IC 95% 1,45 - 5,06) e de prematuridade (OR 5,82; IC 95% 3,10 - 10,92) reduziram quando a adolescente recebeu 6 ou mais consultas de PN. CONCLUSAO: O peso ao nascer foi relacionado ao intervalo intergestacional, ao peso pre-gestacional e ao indice de massa corporal pre-gestacional. A frequencia minima de 6 consultas de assistencia pre-natal constituiu-se em fator de protecao contra o BPN e a prematuridade.OBJECTIVE To identify the association between pre-gestational nutritional status, maternal weight gain, and prenatal care with low birth weight (LBW) and prematurity outcomes in infants of adolescent mothers. METHODS Cross-sectional study with 542 pairs of adolescent mothers and their children attending a public maternity hospital in Rio de Janeiro. Data were collected from medical records. To determine the association between independent variables and the outcomes studied, odds ratio (OR) and a 95% confidence interval (CI) were estimated RESULTS With respect to pre-pregnancy nutritional status of adolescents, 87% had normal weight, 1% were underweight, 10% were overweight, and 2% obese. Inadequate total gestational weight gain (72%) exceeded adequacy (28%). Birth weight was favored with greater gestational weight gain, and reduced with late onset of prenatal care. The comparison between the low birth weight and normal birth weight groups revealed significant differences between variable means: interval between the past pregnancy and current pregnancy (p = 0.022), pre-gestational weight (p = 0.018); pre-gestational body mass index (p < 0.001), and total gestational weight gain (p = 0.047). The odds of LBW (OR 2.70, 95% CI 1.45 to 5.06) and prematurity (OR 5.82, 95% CI 3.10 to 10.92) fell when the adolescent received six or more prenatal visits. CONCLUSION Birth weight was associated with inter-gestational interval, pre-pregnancy weight and body mass index before pregnancy. The minimum frequency of six prenatal care visits was a protective factor against LBW and prematurity.

Anthropometric nutritional evaluation in pregnant Brazilian women: a systematic review

A systematic review was carried out of national and international literature on the available knowledge regarding nutritional assessment methods for anthropometric evaluation during pregnancy and its association with obstetric outcomes among Brazilian women was confirmed. Tracking resulted in 26 studies, where the most commonly used weight-gain assessment method was that proposed by Rosso (1985). Some of these used only pregestational nutritional status Institute of Medicine (1990) or weight gain during pregnancy assessments of World Health Organization (1995). The results indicate the lack of appropriate methods for assessing nutrition during pregnancy, which reflects the low importance prenatal services give to the standardization of anthropomorphic evaluation during pregnancy. There is an urgent need for well-defined methodological studies involving pregnant women that address age differences and intervening factors. Most researchers consider birth weight to be the main outcome of nutritional assessment during gestation to validate anthropometric methods. Outcomes encountered in this study demonstrate a lack of information, both quantitative and qualitative, to evaluate the effectiveness of nutritional assessment methods among pregnant Brazilian women. The development of studies using a rigorous methodology in this field is essential and these should address differences in terms of age and biological, socioeconomic and environmental factors.

Avaliação do SISVAN na gestão de ações de alimentação e nutrição em Minas Gerais, Brasil

The scope of this article is to evaluate the SISVAN as a tool for planning, management and evaluation of food and nutrition actions in primary healthcare in the Unified Health System (SUS). It involved a cross-sectional study composed of a stratified random sample of the municipalities in the State of Minas Gerais. The subjects of the research were municipal officials of SISVAN who filled out a structured questionnaire. Descriptive analysis of the data was performed with the construction of simple and bivariate tables. It was observed that those responsible for SISVAN, collect (50%) and input (55%) weight, height, and food consumption data; whereas 53%, 59% and 71% do not analyze and do not recommend or perform nutrition actions, respectively. This being the case, most of those responsible do not use the information for planning, management and evaluation of food and nutrition traits. The findings show that the SISVAN is not used to its full potential; the data generated have not been used for planning, management and evaluation of nutrition services in primary healthcare in the SUS.

Modeling of Food and Nutrition Surveillance in Primary Health Care

Objetivo: Descrever as etapas de modelizacao da vigilância alimentar e nutricional na Atencao Primaria em Saude no Sistema Unico de Saude, considerando suas atividades, objetivos e metas. Metodos: Foram utilizadas as tecnicas de analise documental e entrevistas semi-estruturadas para identificar os componentes, descrever a intervencao e identificar os potenciais usuarios da avaliacao. Resultados: Foram identificados os objetivos e metas da intervencao, os insumos necessarios, as atividades e os efeitos esperados. A partir dessas informacoes, a intervencao foi modelizada. A utilizacao do modelo logico teorico otimiza tempo, recursos, definicao de indicadores a serem monitorados e aspectos a serem avaliados, identificando com mais clareza qual a contribuicao da intervencao para o alcance dos resultados. Conclusao: A modelizacao possibilitou descrever a vigilância alimentar e nutricional a partir de seus componentes e podera orientar a elaboracao de planos viaveis de monitoramento das acoes da vigilância alimentar e nutricional para sua efetivacao como um instrumento de planejamento intersetorial em nivel local.

Nas entrelinhas do olhar: Apoio Matricial e os profissionais da Estratégia Saúde da Família

Trata-se de artigo fruto de pesquisa qualitativa cujo objetivo foi analisar os significados que os profissionais da Estrategia Saude da Familia atribuiam ao Apoio Matricial. Foram realizadas 18 entrevistas semiestruturadas e para interpretacao dos resultados adotou-se a Analise de Conteudo. Houve consenso sobre a importância do Apoio Matricial para a Estrategia Saude da Familia e que sua construcao aconteceu mais no cotidiano e menos por uma questao normativa. Os profissionais identificaram enfase no enfoque clinico e secundarizacao das acoes de prevencao e coletivas, alem de priorizacao dos nucleos de conhecimento, dificultando a interdisciplinaridade.

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.

Validade de peso, estatura e IMC referidos por puérperas do estudo Nascer no Brasil

ABSTRACT OBJECTIVE To evaluate the accuracy of information on pre-gestational weight, height, pre-gestational body mass index, and weight at the last prenatal appointment, according to maternal characteristics and sociodemographic and prenatal variables. METHODS The study was developed using data from the face-to-face questionnaire and prenatal card (gold standard) of the study “Birth in Brazil, 2011–2012”. To evaluate the differences between the measured and self-reported anthropometric variables, we used the the Kruskal-Wallis test for the variables divided into quartiles. For the continuous variables, we used the Wilcoxon test, Bland-Altman plot, and average difference between the information measured and reported by the women. We estimated sensitivity and the intraclass correlation coefficient. RESULTS In the study, 17,093 women had the prenatal card. There was an underestimation of pre-gestational weight of 1.51 kg (SD = 3.44) and body mass index of 0.79 kg/m2 (SD = 1.72) and overestimation of height of 0.75 cm (SD = 3.03) and weight at the last appointment of 0.22 kg (SD = 2.09). The intraclass correlation coefficients (ICC) obtained for the anthropometric variables were: height (ICC = 0.89), pre-gestational weight (ICC = 0.96), pre-gestational body mass index (ICC = 0.92), and weight at the last appointment (ICC = 0.98). CONCLUSIONS The results suggest that the mentioned anthropometric variables were valid for the study population, and they may be used in studies of populations with similar characteristics.OBJETIVO Avaliar a acuracia das informacoes de peso pre-gestacional, estatura, indice de massa corporal pre-gestacional e peso na ultima consulta de pre-natal, segundo caracteristicas maternas, variaveis sociodemograficas e de pre-natal. METODOS O estudo foi desenvolvido com dados do questionario face a face e do cartao da gestante (padrao-ouro) do estudo “Nascer no Brasil, 2011–2012”. Para […]

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.

Concepções sobre práticas alimentares em mulheres de camadas populares no Rio de Janeiro, RJ, Brasil: transformações e ressignificações

Nesta pesquisa de cunho qualitativo buscou-se compreender as concepcoes e os sentidos atribuidos as praticas alimentares por mulheres de camadas populares com excesso de peso. Questoes associadas as condicoes sociais e culturais da vida urbana configuram um processo de transformacoes marcado pela escassez de tempo e de busca de praticidade. Produtos ultraprocessados, antes vistos como superfluos, sao agora considerados basicos na alimentacao desse grupo de mulheres no Rio de Janeiro. Esta realidade se confronta com o discurso contemporâneo da alimentacao saudavel que, ao fomentar uma demanda de consumo de produtos considerados beneficos a saude, exige das informantes constantes ressignificacoes em relacao ao “comer” que oscilam entre o prazer e a culpa. Discute-se a necessidade de compreender tais expressoes dentro de um quadro de possibilidades restrito e determinado por aspectos micro e macrossociais que conformam os modos contemporâneos de producao e distribuicao de alimentos em nossa sociedade.