Elizabeth Fujimori

Baixo peso ao nascer e condições maternas no pré-natal

This study was carried in the area covered by the Hospital Universitário of the University of São Paulo in order to verify the relationship between birth weight and maternal work and prenatal, nutritional (height, initial and final weight and weight gain during gestation) and socioeconomic-demographic (age, marital status, level of education, family income) conditions. It was based on a sample of 101 children. The occurrence of low birth weight (LBW) (5.1%) did not show association with maternal work nor with prenatal. On the other hand, LBW showed significant association with the following maternal variables: weight gain during the pregnancy under 7 kilograms, mothers age under 20 years old and marital status (single mothers). Despite the low occurrence of LBW, the results point out to the importance of taking measures to reduce LBW, in particular through the control of prenatal weight gain and prenatal among adolescents. Moreover, a policy of educating women, and in particular single women, about pregnancy, childbirth and nutrition seem an obvious necessity.Para verificar como o peso ao nascer se relaciona as condicoes maternas de trabalho, pre-natal, nutricionais (altura, peso inicial, final e ganho na gestacao) e socio-economico-demograficas (idade, situacao conjugal, escolaridade, renda familiar), o presente estudo foi realizado na area de abrangencia do Hospital Universitario da Universidade de Sao Paulo e a amostra foi constituida por 101 criancas. A ocorrencia de baixo peso ao nascer (BPN) foi de 5,1% e nao se associou com o trabalho materno, nem com o pre-natal, porem mostrou associacao significativa com as seguintes variaveis maternas: ganho de peso na gestacao inferior a 7 kg, idade menor que 20 anos e nao ter companheiro. Apesar da baixa ocorrencia de BPN, os resultados evidenciaram a importância do pre-natal para reduzir a ocorrencia de BPN, especialmente por meio do controle do ganho de peso na gestacao, controle da gestacao na adolescencia e tambem priorizando a atencao das mulheres sem companheiro.

Anemia e deficiência de ferro em gestantes adolescentes

ABSTRACT The objective of this study was to characterize iron nutritional status of 79 pregnant adolescents, at firstprenatal consultation ( ≤ 20 weeks of gestation), in the Primary Health System of a district of Great SaoPaulo, through the serum ferritin, serum transferrin, hemoglobin and hematocrit determinations. All thehematologic values studied were smaller for the pregnant adolescents in the second gestationaltrimester than for the ones in the first. Statistically significant differences (p .<.0.05) were found just forhemoglobin. It was verified that 64.3% and 32.1% had, respectively, less than 500 .mg and 300 .mg oforganic iron reservations, and 5.4% presented serious lack of this mineral. By World HealthOrganization criterion 19.0% of the pregnant women w ere iron-deficient (Saturation of Transferrin<.16%) and 13.9% were anemic (Hemoglobin.<.11 g/dl). Index terms: nutritional status, anemia, iron deficiency, ferritin, pregnancy in adolescence. (1) Pesquisa parcialmente financiada pela Fundacao de Auxilio a Pesquisa de Sao Paulo - FAPESP. Processo no 97/11849-2.

Práticas contraceptivas entre jovens universitários: o uso da anticoncepção de emergência

This study investigated contraceptive practices and especially the use of emergency contraception by 487 young students at a public university in São Paulo State. A structured questionnaire was sent by e-mail and completed online in December 2007. Contraceptive methods and use of emergency contraception were investigated. Female and male students reported a high proportion of contraceptive use, mainly condoms and the pill. Half of the students had already used emergency contraception, often when already using some other highly effective method. Among female students, multiple regression analysis showed that current age, age at sexual initiation, not having used condoms in sexual relations, condom failure, and knowing someone that has used emergency contraception were associated with use of the latter. The option for emergency contraception proved to be more closely related to inconsistencies in the use of regular methods than to lack of their use, and can thus be considered a marker for discontinuity in regular contraception.

Prevalência de anemia em gestantes e a fortificação de farinhas com ferro

Avaliou-se o impacto da fortificacao das farinhas com ferro, na prevalencia de anemia e concentracao de hemoglobina de gestantes. Este estudo transversal retrospectivo foi desenvolvido em um Centro de Saude Escola do municipio de Sao Paulo - SP. Os dados, colhidos de setembro a dezembro de 2006, foram obtidos de 750 prontuarios de gestantes distribuidas em dois grupos (nao fortificado e fortificado), antes e apos a fortificacao. Gestantes com nivel de hemoglobina inferior a 11g/dl foram consideradas anemicas. Realizou-se analise de regressao linear multipla. A anemia afetava 9,2% e 8,6% das gestantes, antes e apos a implantacao do programa, respectivamente (p>0,05). A analise multipla nao evidenciou diferenca estatistica na media de hemoglobina entre os grupos (p=0,117). Os resultados indicaram uma baixa prevalencia de anemia e medias de hemoglobina similares entre os grupos, fato que provavelmente nao permitiu constatar o efeito da fortificacao das farinhas.

Aleitamento materno e níveis de hemoglobina em crianças menores de 2 anos em município do estado de São Paulo, Brasil

OBJECTIVE: The objective of this study is to assess the relationship between breastfeeding and hemoglobin concentration in children under 2 years of age in Itupeva City, SP, Brazil. METHODS: This cross-sectional population-based study was carried out in a representative sample of 254 children under 2 years of age randomly selected in the urban area of Itupeva, SP. The sampling process was done in three stages. The recommendations made by the World Health Organization were used to classify breastfeeding. Hemoglobin concentration was measured by the cyanmethemoglobin method, using the HemoCue system and anemia was defined when hemoglobin concentration was below 11.0g/dL. RESULTS: The prevalence of anemia was 41.7%. Anemia was more frequent among children who were weaned before 6 months (p<0.05). The mean hemoglobin levels of breastfed children were significantly higher among children under 6 months (p<0.05). Children who were exclusively or predominantly breastfed in the first six months of life had higher mean hemoglobin levels than the remaining children (12.3g/dL versus 10.99g/dL; p=0.022). CONCLUSIONS: The results suggest that partial or total substitution of breast milk before six months of age was associated with lower mean hemoglobin levels. The high frequency of anemia and the low percentage of children who were exclusively breastfed indicate that programs are needed to control nutritional anemia in this city and to promote exclusive breastfeeding in the first six months.

Food Consumption and Iron Intake of Pregnant and Reproductive Aged Women

Comparar la practica alimentar y el consumo de alimentos fuentes de hierro, naturales y fortificados, de mujeres en edad reproductiva, gestantes o no, constituye el objetivo de esta investigacion. Se trata de un estudio transversal, desarrollado en un centro de salud del municipio de Sao Paulo, en el cual participaron 61 mujeres, siendo 30 gestantes. Se utilizo un cuestionario de frecuencia de consumo alimentar y un recordatorio de 24h. Las principales fuentes naturales de hierro fueron frijoles y hojas verdes. Alimentos fortificados tambien tuvieron participacion importante. Hubo una pequena diferencia estadisticamente significativa entre el consumo alimentar de las gestantes y no gestantes. Se observo inadecuacion del consumo de hierro, folato y calcio en los dos grupos. Las mujeres no gestantes atenderian la demanda de hierro, considerandose el adicional recomendado para la fortificacion de las harinas, sin embargo, las gestantes no. Hay necesidad de implementar estrategias combinadas: fortificacion de los alimentos, suplemento medicamentoso para gestantes y orientacion nutricional para las mujeres en general.Comparar a pratica alimentar e o consumo de alimentos fontes de ferro, naturais e fortificados, de mulheres em idade reprodutiva, gestantes ou nao, constituiu o objetivo desta pesquisa. Estudo transversal, desenvolvido em um centro de saude do municipio de Sao Paulo, envolvendo 61 mulheres, sendo 30 gestantes. Utilizou-se questionario de frequencia de consumo alimentar e recordatorio de 24h. As principais fontes naturais de ferro foram feijao e folhas verdes. Alimentos fortificados tambem tiveram participacao importante. Houve pequena diferenca estatisticamente significativa entre o consumo alimentar das gestantes e nao gestantes. Observou-se inadequacao do consumo de ferro, folato e calcio nos dois grupos. As mulheres nao gestantes atenderiam a demanda de ferro, considerando-se o adicional recomendado para a fortificacao das farinhas, porem, as gestantes nao. Ha necessidade de estrategias combinadas: fortificacao dos alimentos, suplementacao medicamentosa para gestantes e orientacao nutricional para as mulheres em geral.This study compares the eating habits and consumption of natural and fortified iron sources in pregnant and reproductive aged women. This cross-sectional study was developed in a health center located in São Paulo, SP, Brazil. We studied 61 women, of which 30 were pregnant. A food frequency questionnaire and a 24-hour recall instrument were used. The main natural sources of iron were beans and greens, although fortified foods were also an important source. There was little statistically significant difference between the food consumption of pregnant and non-pregnant women. Inadequate intake of iron, folate and calcium was observed in both groups. Non-pregnant women meet the iron recommendation, considering the iron added in fortified foods, though pregnant women do not. These results suggest the need for mixed strategies: food fortification, iron supplements for pregnant women and nutritional instruction for women in general.

Conhecimento materno/familiar sobre o cuidado prestado à criança doente

Improving family and community practices is one of the components of the strategy Integrated Management of Childhood Illness (IMCI). Considering that In Brazil, IMCI is being implemented in the context of Family Health Program (PSF), the objective of this study was to identify maternal knowledge in relation to care provided to child with respiratory disease or diarrhea in two health units with different assistance models, with PSF and without PSF The results showed that the level of maternal/familiar knowledge were similar in both assistance models. Under a scientific point of view, the mothers/families showed overshot knowledge in relation to care provided to child with diarrhea. The finding show that mother and caretaker communication need to improve, even health units with PSF.Improving family and community practices is one of the components of the strategy Integrated Management of Childhood Illness (IMCI). Considering that In Brazil, IMCI is being implemented in the context of Family Health Program (PSF), the objective of this study was to identify maternal knowledge in relation to care provided to child with respiratory disease or diarrhea in two health units with different assistance models, with PSF and without PSF. The results showed that the level of maternal/familiar knowledge were similar in both assistance models. Under a scientific point of view, the mothers/families showed overshot knowledge in relation to care provided to child with diarrhea. The finding show that mother and caretaker communication need to improve, even health units with PSF.

Anemia in Brazilian pregnant women before and after flour fortification with iron

OBJECTIVE To compare prevalence of anemia and hemoglobin (Hb) levels in Brazilian pregnant women before and after flour fortification with iron. METHODS A repeated cross-sectional panel study of public health care centers of municipalities in the five Brazilian regions was conducted. Retrospective data were obtained from 12,119 medical records of pregnant women distributed in two groups: before fortification (delivery prior to June 2004) and after fortification (date of last period after June 2005). Anemia was defined as Hb<11.0 g/dl. Hb levels according to gestational age were assessed using two references from the literature. Statistical analysis was carried out using chi-squared tests, Students t tests, and logistic regression, with a significance level of 5%. RESULTS In the total sample, prevalence of anemia fell from 25% to 20% after fortification (p<0.001). However, important regional differences were evident: while significant reductions were seen in the Northeast (37% to 29%) and North (32% to 25%) regions, where pre-fortification prevalence was high, smaller reductions were seen in the Southeast (18% to 15%) and South (7% to 6%) regions, where prevalence was low. Hb levels according to gestational age were slightly higher in the first months of pregnancy and lower after the third or fourth months, depending on the reference used. Logistic regression analysis showed that group, geographic region, marital status, trimester of pregnancy, initial nutritional status, and prior pregnancy were associated with anemia (p<0.05). CONCLUSIONS Prevalence of anemia decreased after fortification, but remains high in the North and Northeast regions. Although fortification may have played a role in this favorable outcome, the contribution of other public policies implemented during the studied period should also be considered.

Anemia em gestantes brasileiras antes e após a fortificação das farinhas com ferro

OBJECTIVE To compare prevalence of anemia and hemoglobin (Hb) levels in Brazilian pregnant women before and after flour fortification with iron. METHODS A repeated cross-sectional panel study of public health care centers of municipalities in the five Brazilian regions was conducted. Retrospective data were obtained from 12,119 medical records of pregnant women distributed in two groups: before fortification (delivery prior to June 2004) and after fortification (date of last period after June 2005). Anemia was defined as Hb<11.0 g/dl. Hb levels according to gestational age were assessed using two references from the literature. Statistical analysis was carried out using chi-squared tests, Students t tests, and logistic regression, with a significance level of 5%. RESULTS In the total sample, prevalence of anemia fell from 25% to 20% after fortification (p<0.001). However, important regional differences were evident: while significant reductions were seen in the Northeast (37% to 29%) and North (32% to 25%) regions, where pre-fortification prevalence was high, smaller reductions were seen in the Southeast (18% to 15%) and South (7% to 6%) regions, where prevalence was low. Hb levels according to gestational age were slightly higher in the first months of pregnancy and lower after the third or fourth months, depending on the reference used. Logistic regression analysis showed that group, geographic region, marital status, trimester of pregnancy, initial nutritional status, and prior pregnancy were associated with anemia (p<0.05). CONCLUSIONS Prevalence of anemia decreased after fortification, but remains high in the North and Northeast regions. Although fortification may have played a role in this favorable outcome, the contribution of other public policies implemented during the studied period should also be considered.

Anemia em gestantes de municípios das regiões Sul e Centro-Oeste do Brasil

Received: 09/15/2009 Approved: 10/27/2009 Portuguese / Engli h: www.scielo.br/reeusp RESUMO Objetivou-se analisar a distribuicao da anemia em gestantes da rede basica de saude de dois municipios, na regiao Sul e CentroOeste do Brasil. Estudo transversal retrospectivo e descritivo desenvolvido a partir de dados de prontuarios de 954 e 781 gestantes em Cuiaba-MT e Maringa-PR, respectivamente. Coletaram-se dados de caracterizacao sociodemografica, de pre-natal e indicadores sociais. Foram consideradas anemicas, as mulheres com hemoglobina inferior a 11g/dL. A desigualdade social existente entre os municipios foi evidente. Gestantes atendidas em Cuiaba-MT apresentavam caracteristicas sociodemograficas significativamente mais precarias. A prevalencia de anemia era significativamente maior e valores medios de hemoglobina menores em Cuiaba-MT, independentemente da idade gestacional. Encontrou-se associacao dos niveis de hemoglobina com a idade, situacao conjugal, numero de gestacoes anteriores, estado nutricional e trimestre gestacional. As diferencas regionais na ocorrencia da anemia gestacional sao socialmente determinadas, o que deve ser considerado nas propostas de intervencao em saude coletiva.Objetivou-se analisar a distribuicao da anemia em gestantes da rede basica de saude de dois municipios, na regiao Sul e Centro-Oeste do Brasil. Estudo transversal retrospectivo e descritivo desenvolvido a partir de dados de prontuarios de 954 e 781 gestantes em Cuiaba-MT e Maringa-PR, respectivamente. Coletaram-se dados de caracterizacao sociodemografica, de pre-natal e indicadores sociais. Foram consideradas anemicas, as mulheres com hemoglobina inferior a 11g/dL. A desigualdade social existente entre os municipios foi evidente. Gestantes atendidas em Cuiaba-MT apresentavam caracteristicas sociodemograficas significativamente mais precarias. A prevalencia de anemia era significativamente maior e valores medios de hemoglobina menores em Cuiaba-MT, independentemente da idade gestacional. Encontrou-se associacao dos niveis de hemoglobina com a idade, situacao conjugal, numero de gestacoes anteriores, estado nutricional e trimestre gestacional. As diferencas regionais na ocorrencia da anemia gestacional sao socialmente determinadas, o que deve ser considerado nas propostas de intervencao em saude coletiva.