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

Abstract

This study assessed excessive weight gain in the second and third trimesters of pregnancy and the influence of biological, socio-demographic, behavioral, and reproductive factors and co-morbidity. The cross-sectional sample included 240 pregnant women at low risk of obstetric complications, followed from May 2000 to July 2001. There were 347 patient records in the original database, but 107 were excluded because of age (42 patients were younger than 18 years) or lack of data on weight (65 women). Excessive weight gain was common in all categories of baseline nutritional status, but was more frequent in the second trimester among women who were already overweight or obese upon entering pregnancy. In the third trimester, variables associated with excessive weekly weight gain were schooling and marital status.

Nutritional status and weight gain in pregnant women

“…The evaluation of the nutritional status showed that a high percentage of the women started the pregnancy overweight/obese, a result slightly higher to that found in other studies developed in the primary healthcare system (7)(8)(9) . A cohort study that followed more than 3000 women attending general prenatal services of the Brazilian National Health System (SUS) found that 29%…”

“…Other studies also found high percentages of pregnant women with weight gain above the recommended: 29% in Rio de Janeiro (17) ; 36% in Sao Paulo (18) ; 39%, 44% and 56% in pregnant women who started the pregnancy underweight, with adequate weight and overweight/obese, respectively, in Recife (9) ; 44% in Campina Grande, PB (8) ; and 45% in Rio Grande do Sul (11) . In addition to being associated with pre-gestational overweight/ obesity, excessive weight gain has been associated with the social variables of the women, such as better education and stable marital status (with partner) (9) . It is noteworthy that in the present study, a higher proportion of women started the pregnancy overweight/obese, had more than 8 years of study and lived with a partner.…”

“…Another longitudinal study, conducted with pregnant women attending the Family Health Program of Campina Grande, PB, found 28% initially overweight/ obese, a condition statistically associated with gestational arterial hypertension and the postpartum nutritional status (8) . A descriptive study with 240 pregnant women of low obstetric risk, attending a public prenatal service of the municipality of Recife, PE, verified that 26% were initially overweight/obese, which was associated with excessive weekly weight gain (9) . Furthermore, a high percentage of women finished the pregnancy overweight/obese (40.8%)…”

“…Although many studies emphasize excessive weight gain as an issue that requires immediate attention in the prenatal services (3)(4)(8)(9)11,(17)(18) , the finding that a high percentage of pregnant women presented insufficient weight gain (36.4%) is also disturbing, a situation that is associated with increased risk of premature birth and low birth weight (4,20) . These findings reinforce the importance of nutritional monitoring in the prenatal period, which should focus on modifiable variables, such as weight gain and the diet, and benefits women at risk of both excessive and insufficient weight gain (21) , through the monitoring of weight gain and guidance on healthy eating practices (1) .…”

Gravidez e comportamento alimentar em gestantes de uma comunidade urbana de baixa renda no Município do Rio de Janeiro, Brasil

“…No Brasil, pesquisas que investigam o tema alimentação na gestação priorizam metodologias quantitativas com objetivo de avaliar o estado nutricional materno, o ganho de peso gestacional e a associação com variáveis de interesse 3,4,5 . De forma menos constante, alguns estudos incorporam o conhecimento das crenças, proibições e prescrições que interferem no comportamento e nas práticas alimentares de gestantes, puérperas e lactantes 6,7,8 .…”