Elisa Maria de Aquino Lacerda

Determinants of weight gain in pregnant women attending a public prenatal care facility in Rio de Janeiro, Brazil: a prospective study, 2005-2007.

The objective of this study was to evaluate the determinants of weight gain during pregnancy. The study adopted a prospective cohort design with four follow-up waves and included a sample of 255 pregnant women that received prenatal care at a public health care facility in Rio de Janeiro, Brazil. A mixed-effects linear longitudinal regression model was used, having as the dependent variable the weight assessed in four follow-up waves, and as independent variables: demographic, socioeconomic, reproductive, behavioral, and nutritional data. Mean weight gain was 0.413kg per gestational week, consistent with recommendations by the Institute of Medicine. Per capita family income and smoking were associated with total weight gain during gestation. According to the longitudinal multiple linear regression model, age (beta = 0.6315), menarche (beta = -2.3861), triglycerides (beta = 0.0437), blood glucose (beta = 0.1544), and adequacy of energy consumption (beta = -0.0642) were associated with gestational weight gain. Special attention should be given to these sub-groups, due to increased risk of excessive weight gain.

Fatores associados com a retenção e o ganho de peso pós-parto: uma revisão sistemática

INTRODUCAO: A retencao de peso apos o parto e um dos determinantes da obesidade em mulheres. Seu desenvolvimento esta relacionado com o ganho de peso gestacional, paridade, idade, situacao marital, consumo energetico, atividade fisica e lactacao, mas as associacoes encontradas tem se mostrado inconclusivas e contraditorias. Objetivos: Avaliar estudos que identificaram fatores preditores da retencao e ganho de peso apos o parto. MATERIAL E METODOS: Foi realizada uma revisao de literatura na Base de Dados LILACS e MEDLINE, referente aos anos de 1993 a 2003. RESULTADOS: Vinte e oito artigos foram identificados, sendo 23 estudos de coorte, quatro estudos transversais e um estudo caso-controle. A maioria dos estudos foi realizada nos EUA e o tempo de acompanhamento apos o parto ocorreu principalmente entre seis semanas e 24 meses. Cerca de 25% dos estudos apresentaram perdas superiores a 30%, 61% incluiram adolescentes na amostra e 75% nao aferiram o peso pre-gestacional. Sete estudos foram considerados de melhor qualidade, pois utilizaram o peso pre-gestacional medido, incluiram grupo de comparacao, excluiram adolescentes, apresentaram perdas de seguimento inferiores a 30% e controlaram para variaveis de confundimento. CONCLUSAO: Ganho de peso gestacional, raca negra e paridade estao associados positivamente com a retencao de peso pos-parto. As evidencias sao contraditorias para a variavel lactacao e insuficientes para as variaveis consumo alimentar e atividade fisica. Sao necessarios estudos cuidadosamente desenhados para esclarecer estas questoes.

Consumo alimentar na gestação e no pós-parto segundo cor da pele no município do Rio de Janeiro

OBJETIVO: Avaliar o consumo alimentar durante a gestacao e pos-parto, segundo cor da pele. METODOS: Estudo longitudinal prospectivo que incluiu 467 mulheres entre 15 e 45 anos no periodo pos-parto, no municipio do Rio de Janeiro, entre 1999 e 2001. Foi aplicado um questionario de frequencia de consumo de alimentos aos 15 dias pos-parto (consumo referente ao periodo da gestacao) e aos seis meses (consumo referente ao periodo pos-parto). Foi utilizada analise de covariância para analisar diferencas no consumo alimentar, segundo cor da pele, controlada pela escolaridade. RESULTADOS: Durante a gestacao, pretas e pardas apresentaram consumo de energia 13,4% e 9,1% (p=0,009 e p=0,028) e consumo de carboidrato 15,1% e 10,5% maior que brancas (p=0,005 e p=0,014), respectivamente. Mulheres pretas e brancas apresentaram consumo energetico 34% e 20% acima das recomendacoes nutricionais, respectivamente (p=0,035). Durante o periodo pos-parto, as pretas apresentaram consumo de energia 7,7% maior e consumo de lipidios 14,8% maior que as brancas; consumo de acidos graxos saturados 23,8% maior que brancas (p=0,003) e 13% maior que pardas (p=0,046). A adequacao de consumo de lipidios e acidos graxos saturados foi maior em pretas que em brancas (p=0,024 e p=0,011, respectivamente). CONCLUSOES: Os resultados mostram ser necessario revisar estrategias de intervencao nutricional no pre-natal e implementar assistencia nutricional no pos-parto, para ajustar o consumo alimentar a niveis adequados, considerando as diferencas por cor/raca identificadas.

Avaliação da estrutura de sete unidades de saúde da família para a oferta da assistência nutricional no pré-natal no município do Rio de Janeiro, Brasil

OBJECTIVES: to evaluate the extent to which seven family health units in the municipality of Rio de Janeiro are equipped to provide prenatal care on nutrition. METHODS: a cross-sectional study was carried out in 2008. Seven family health units were selected and their structure was observed directly. Seven health workers and 230 pregnant women were interviewed at these units. The building structure, material resources, referral system, human resources and norms and routines were examined at each unit. RESULTS: direct observation and the interviews with the health workers ascertained that all the units had a suitable building structure and material resources. The norm that was least commonly complied with was the preventive maintenance of scales. The Ministry of Healths current prenatal card was found to have been implemented for 45% of the pregnant women. Access to ferrous sulfate and folic acid were reported by around 70% of pregnant women. There was found to be a shortfall in human resources and in referral of pregnant women to nutritionists. CONCLUSIONS: the study points out the importance of ensuring the minimum team size and installing Family Health Support Unites, when expanding the scope and improving the integration of prenatal care.

Dietary patterns in pregnancy and birth weight

OBJECTIVE To analyze if dietary patterns during the third gestational trimester are associated with birth weight. METHODS Longitudinal study conducted in the cities of Petropolis and Queimados, Rio de Janeiro (RJ), Southeastern Brazil, between 2007 and 2008. We analyzed data from the first and second follow-up wave of a prospective cohort. Food consumption of 1,298 pregnant women was assessed using a semi-quantitative questionnaire about food frequency. Dietary patterns were obtained by exploratory factor analysis, using the Varimax rotation method. We also applied the multivariate linear regression model to estimate the association between food consumption patterns and birth weight. RESULTS Four patterns of consumption – which explain 36.4% of the variability – were identified and divided as follows: (1) prudent pattern (milk, yogurt, cheese, fruit and fresh-fruit juice, cracker, and chicken/beef/fish/liver), which explained 14.9% of the consumption; (2) traditional pattern, consisting of beans, rice, vegetables, breads, butter/margarine and sugar, which explained 8.8% of the variation in consumption; (3) Western pattern (potato/cassava/yams, macaroni, flour/farofa/grits, pizza/hamburger/deep fried pastries, soft drinks/cool drinks and pork/sausages/egg), which accounts for 6.9% of the variance; and (4) snack pattern (sandwich cookie, salty snacks, chocolate, and chocolate drink mix), which explains 5.7% of the consumption variability. The snack dietary pattern was positively associated with birth weight (β = 56.64; p = 0.04) in pregnant adolescents. CONCLUSIONS For pregnant adolescents, the greater the adherence to snack pattern during pregnancy, the greater the baby’s birth weight.

Avaliação do processo da assistência nutricional no pré-natal em sete unidades de saúde da família do Município do Rio de Janeiro

Nutritional care is of great importance in the prenatal period and the family health teams play a significant role in expanding the coverage of prenatal care. In this manner, the scope of this study was to evaluate the prenatal nutritional care process in seven family health units in the city of Rio de Janeiro. In 2008, a cross-sectional study was conducted and 230 pregnant women were interviewed and copies of their prenatal cards were obtained. The compliance of the process with the pre-established norms and criteria of the Ministry of Health was evaluated. Measurement and recording of blood pressure and weight and prescription of supplements and blood tests on the prenatal card are established steps in routine prenatal care. However, the results indicated that there was under-recording of stature, initial weight, edema, BMI by gestational age and laboratory tests results on the prenatal card. A lack of specific instruction on adequate use of the iron supplement, food consumption and weight gain was observed. The results indicated a pressing need for prenatal nutritional care and revealed deficiencies in this process, stressing the importance of minimum training for the health teams and the implementation of Family Health Support Centers.

Fatores associados à introdução precoce de leite artificial, Município do Rio de Janeiro, 2007

Este estudo objetivou analisar a associacao entre introducao de leite artificial e fatores demograficos e socioeconomicos em uma amostra representativa de 1.057 maes de criancas menores de seis meses, atendidas em 27 unidades basicas de saude no Municipio do Rio de Janeiro, no ano de 2007. As informacoes sobre caracteristicas maternas e tipo de alimentacao da crianca foram obtidas pela aplicacao de um questionario a mae apos uma consulta pediatrica. Para estimar a associacao entre as variaveis maternas e a introducao de leite artificial foi utilizado um modelo de regressao logistica multivariado com ponderacao, efeito de desenho e controlado pela idade da crianca. Os resultados apontaram que a chance de introducao de leite artificial foi significativamente maior, no nivel de 5%, entre as maes com trabalho informal, menos de oito anos de estudo e sem experiencia em amamentar. Verificou-se a presenca de interacao negativa entre situacao conjugal e a idade materna. Dentre as mulheres com companheiro, as adolescentes mostraram uma chance 2,06 vezes maior (IC 95% de 1,32 a 3,21) de introduzir leite artificial quando comparadas com as adultas, enquanto entre as mulheres sem companheiro, a adolescencia aparece como um fator protetor para a introducao de leite artificial (OR = 0,24, IC 95% 0,10 a 0,58). E necessaria a capacitacao de profissionais de saude para oferecer orientacoes sobre amamentacao atraves de uma abordagem que considere as caracteristicas maternas.

Acolhimento e características maternas associados à oferta de líquidos a lactentes

OBJETIVO: Identificar caracteristicas maternas y acciones de acogimiento en las madres de ninos menores de seis meses asociadas a la oferta precoz de liquidos. METODOS: Estudio transversal realizado en 2007 con muestra representativa de madres de ninos menores de seis meses (n=1.057) usuarias de unidades basicas de salud en la ciudad de Rio de Janeiro, Sureste de Brasil. Para estimar la asociacion entre las variables explicativas y la oferta de liquidos se utilizo un modelo de regresion logistica multivariada con ponderacion, efecto de diseno y controlado por la edad del nino. RESULTADOS: De las madres, 32% no recibieron la tarjeta de acogimiento en la maternidad, 47% no recibieron orientacion sobre amamantamiento en la primera ida a la USB posterior al parto y 55% relataron la oferta de liquidos a los lactantes. Mujeres sin experiencia anterior en amamantar por al menos seis meses presentaron oportunidad de oferta de liquidos mayor que aquellas con experiencia (OR=1,57;IC 95%:1,16;2.13). Las que no recibieron orientacion sobre amamantamiento en la primera ida a la unidades de salud posterior al parto tuvieron oportunidad 58% mayor de ofrecer liquidos que aquellas que recibieron orientacion. La oferta de liquidos se mostro positivamente asociada con la adolescencia entre mujeres con companero (OR=2,17; IC 95%: 1,10;4,30) y negativamente asociada con la adolescencia entre aquellas sin companero (OR=0,31; IC 95%: 0,11;0,85). Entre mujeres con menos de ocho anos de estudio, las que no recibieron orientacion sobre amamantamiento posterior al nacimiento del nino presentaron oportunidad de oferta de liquidos 1,8 veces mayor que aquellas que recibieron orientacion. CONCLUSIONES: Edad, situacion conyugal y experiencia anterior en amamantar son caracteristicas maternas asociadas a la oferta de liquidos para ninos menores de seis meses. El recibimiento de orientacion precoz sobre amamantamiento materno puede reducir el ofrecimiento de liquidos a los lactantes.OBJECTIVE To identify the maternal characteristics and welcoming actions towards mothers of infants aged less than six months associated with early liquid offer. METHODS Cross-sectional study performed in 2007, with a representative sample of mothers of infants aged less than six months (n=1,057), users of Primary Health Care (PHC) Units, in the city of Rio de Janeiro, Southeastern Brazil. A multivariate logistic regression model was used to estimate the association between explanatory variables and liquid offer, with weighing and design effect and controlled for infant age. RESULTS Of all mothers, 32% did not receive the welcoming card in the maternity hospital, 47% did not receive guidance on breastfeeding at their first visit to the PHC unit after childbirth and 55% reported they had offered liquids to their infants. Women without at least six months of previous breastfeeding experience were more likely to offer liquids than those with such experience (OR=1.57; 95% CI: 1.16;2.13). Mothers who had not received guidance on breastfeeding at their first visit to the UBS after childbirth were 58% more likely to offer liquids than those who had received it. Liquid offer was positively associated with adolescence among women with a partner (OR=2.17; 95% CI: 1.10;4.30) and negatively associated with adolescence among those without a partner (OR=0.31; 95% CI: 0.11;0.85). Among women with less than eight years of education, those who had not received guidance on breastfeeding after childbirth were 1.8 times more likely to offer liquids than others who had received it. CONCLUSIONS Age, marital status and previous breastfeeding experience are maternal characteristics associated with liquid offer to infants aged less than six months. Receiving early guidance on breastfeeding could reduce liquid offer to infants.

Blood Pressure in Healthy Pregnancy and Factors Associated With No Mid-Trimester Blood Pressure Drop: A Prospective Cohort Study

BACKGROUND The well-known mid-trimester drop in blood pressure (BP) during normal pregnancy was recently questioned. OBJECTIVE To describe longitudinal changes in BP during healthy pregnancies and to investigate factors associated with no mid-trimester drop in BP. METHODS A prospective cohort with 158 healthy pregnant women was followed up in a public health care center in Rio de Janeiro, Brazil. We used linear mixed-effects models to estimate longitudinal changes in systolic BP (SBP) and diastolic BP (DBP) during pregnancy. Poisson regression models were performed to identify factors associated with no mid-trimester drop in BP. RESULTS Significant mid-trimester increase in SBP (5.6 mm Hg; 95% confidence interval (CI) = 4.6-6.7) and DBP (4.4 mm Hg; 95% CI = 3.4-5.3) was observed in 44.3% and 39.9% of the sample, respectively. Women (37.1%) who had not a mid-trimester SBP drop still had a DBP drop. White skin color (incidence ratio (IR): 1.71; 95% CI = 1.22-2.39), family history of hypertension (IR: 1.93; 95% CI = 1.29-2.89), early pregnancy obesity (IR: 2.29; 95% CI = 1.27-4.11), outside temperature variation (IR: 1.45; 95% CI = 1.00-2.10), and gestational weight gain from the first to second trimester (IR: 1.71; 95% CI = 1.01-2.88 and IR: 2.32; 95% CI = 1.39-3.89 for second and third tertiles) were characteristics associated with no mid-trimester drop in SBP. The same characteristics were associated with no mid-trimester drop in DBP, except family history of hypertension and outside temperature variation. CONCLUSIONS Some women without a mid-trimester SBP drop still present a DBP drop. The different patterns of mid-trimester change in BP seem to be determined by preexisting and pregnancy-related factors.

User embracement and maternal characteristics associated with liquid offer to infants

OBJETIVO: Identificar caracteristicas maternas y acciones de acogimiento en las madres de ninos menores de seis meses asociadas a la oferta precoz de liquidos. METODOS: Estudio transversal realizado en 2007 con muestra representativa de madres de ninos menores de seis meses (n=1.057) usuarias de unidades basicas de salud en la ciudad de Rio de Janeiro, Sureste de Brasil. Para estimar la asociacion entre las variables explicativas y la oferta de liquidos se utilizo un modelo de regresion logistica multivariada con ponderacion, efecto de diseno y controlado por la edad del nino. RESULTADOS: De las madres, 32% no recibieron la tarjeta de acogimiento en la maternidad, 47% no recibieron orientacion sobre amamantamiento en la primera ida a la USB posterior al parto y 55% relataron la oferta de liquidos a los lactantes. Mujeres sin experiencia anterior en amamantar por al menos seis meses presentaron oportunidad de oferta de liquidos mayor que aquellas con experiencia (OR=1,57;IC 95%:1,16;2.13). Las que no recibieron orientacion sobre amamantamiento en la primera ida a la unidades de salud posterior al parto tuvieron oportunidad 58% mayor de ofrecer liquidos que aquellas que recibieron orientacion. La oferta de liquidos se mostro positivamente asociada con la adolescencia entre mujeres con companero (OR=2,17; IC 95%: 1,10;4,30) y negativamente asociada con la adolescencia entre aquellas sin companero (OR=0,31; IC 95%: 0,11;0,85). Entre mujeres con menos de ocho anos de estudio, las que no recibieron orientacion sobre amamantamiento posterior al nacimiento del nino presentaron oportunidad de oferta de liquidos 1,8 veces mayor que aquellas que recibieron orientacion. CONCLUSIONES: Edad, situacion conyugal y experiencia anterior en amamantar son caracteristicas maternas asociadas a la oferta de liquidos para ninos menores de seis meses. El recibimiento de orientacion precoz sobre amamantamiento materno puede reducir el ofrecimiento de liquidos a los lactantes.OBJECTIVE To identify the maternal characteristics and welcoming actions towards mothers of infants aged less than six months associated with early liquid offer. METHODS Cross-sectional study performed in 2007, with a representative sample of mothers of infants aged less than six months (n=1,057), users of Primary Health Care (PHC) Units, in the city of Rio de Janeiro, Southeastern Brazil. A multivariate logistic regression model was used to estimate the association between explanatory variables and liquid offer, with weighing and design effect and controlled for infant age. RESULTS Of all mothers, 32% did not receive the welcoming card in the maternity hospital, 47% did not receive guidance on breastfeeding at their first visit to the PHC unit after childbirth and 55% reported they had offered liquids to their infants. Women without at least six months of previous breastfeeding experience were more likely to offer liquids than those with such experience (OR=1.57; 95% CI: 1.16;2.13). Mothers who had not received guidance on breastfeeding at their first visit to the UBS after childbirth were 58% more likely to offer liquids than those who had received it. Liquid offer was positively associated with adolescence among women with a partner (OR=2.17; 95% CI: 1.10;4.30) and negatively associated with adolescence among those without a partner (OR=0.31; 95% CI: 0.11;0.85). Among women with less than eight years of education, those who had not received guidance on breastfeeding after childbirth were 1.8 times more likely to offer liquids than others who had received it. CONCLUSIONS Age, marital status and previous breastfeeding experience are maternal characteristics associated with liquid offer to infants aged less than six months. Receiving early guidance on breastfeeding could reduce liquid offer to infants.