Post-partum weight retention in Northeastern Brazilian women: a prospective NISAMI cohort study.

BACKGROUND: Weight retention during the post-partum period is associated with excessive weight gain. OBJECTIVES: To investigate factors associated with maternal weight retention at six months post-partum (PPWR). DESIGN AND SETTING: A prospective cohort study was conducted with 127 women monitored using prenatal services. METHODS: The outcome variable was represented by post-partum maternal weight retention and calculated as the difference between the mother's weight at sixth month post-partum and her pregestational weight. RESULTS: The mean age of the pregnant women was 26.7 ± 5.25 years old, and the post-partum maternal weight retention was 46.5%. The proximal determinants showed a direct association with PPWR after adjusting for the distal and intermediate variables: excessive gestational weight gain (odds ratio [OR]:3.34; confidence interval [CI]:1.16-9.59), greater adhesion to dietary intake pattern 2 (composed of red meats and derivatives, eggs, industrialized foods, and coffee) (OR:2.70; CI:1.16-6.32), and the absence of exclusive maternal breastfeeding in the first month (OR:3.40; CI:1.27-9.12), as well as primiparity (OR:2.36; CI:1.00-5.55), an intermediate determinant. Insufficient weight gain in pregnancy was inversely associated with the outcome (OR:0.35; CI:0.31-0.93). CONCLUSIONS: Among the hierarchical determinants, proximal factors were interrelated with maternal weight retention, indicating that excessive total weight gain, an inadequate dietary intake pattern, and the absence of exclusive maternal breastfeeding in the first month of life work as dampeners of the return to pre-gestational weight. Prepartum and post-partum care interventions can contribute to reducing excess weight in women.

Validation and calibration of the Food Consumption Frequency Questionnaire for pregnant women

ABSTRACT BACKGROUND: Few food frequency questionnaires (FFQ) have been validated for pregnant women, particularly those in small- and medium-sized cities in different regions of Brazil. OBJECTIVES: To validate and calibrate a semiquantitative FFQ for pregnant women. DESIGN AND SETTING: The study was validated with a sample of 50 pregnant women (≥ 18 years) enrolled in Brazilian prenatal services. METHODS: An FFQ and a 24-hour recall were used to evaluate dietary intake. Dietary variables were tested for normality and log-converted when asymmetrical. Pearson's Correlation Coefficient was used to validate the questionnaire. Linear regression was applied to extract calibration factors. All variables underlying the consumption analysis were adjusted for energy. RESULTS: The mean age of the pregnant women was 26 years ± 6.2 years; 58% were in their first trimester, and 30% were identified as overweight/obese. The Pearson correlation analysis results indicated that the FFQ overestimated energy and nutrient intake, whose coefficients ranged from −0.15 (monounsaturated fat) to 0.50 (carbohydrate). Adjusting for energy reduced the mean values of intake coefficients, which now ranged from −0.33 (sodium) to 0.96 (folate). The calibration analysis results indicated variation in the coefficients from −0.23 (sodium) to 1.00 (folate). Calibration produced satisfactory coefficients for the FFQ compared with the reference standard for energy, macronutrients, monounsaturated fat, cholesterol, vitamins B12/C, folate, sodium, iron, and calcium. CONCLUSIONS: After validating and calibrating tests, we observed that the FFQ was adequately accurate for assessing the food consumption of the pregnant women in this study.

Validation and calibration of the Food Consumption Frequency Questionnaire for pregnant women.

BACKGROUND: Few food frequency questionnaires (FFQ) have been validated for pregnant women, particularly those in small- and medium-sized cities in different regions of Brazil. OBJECTIVES: To validate and calibrate a semiquantitative FFQ for pregnant women. DESIGN AND SETTING: The study was validated with a sample of 50 pregnant women (≥ 18 years) enrolled in Brazilian prenatal services. METHODS: An FFQ and a 24-hour recall were used to evaluate dietary intake. Dietary variables were tested for normality and log-converted when asymmetrical. Pearson's Correlation Coefficient was used to validate the questionnaire. Linear regression was applied to extract calibration factors. All variables underlying the consumption analysis were adjusted for energy. RESULTS: The mean age of the pregnant women was 26 years ± 6.2 years; 58% were in their first trimester, and 30% were identified as overweight/obese. The Pearson correlation analysis results indicated that the FFQ overestimated energy and nutrient intake, whose coefficients ranged from -0.15 (monounsaturated fat) to 0.50 (carbohydrate). Adjusting for energy reduced the mean values of intake coefficients, which now ranged from -0.33 (sodium) to 0.96 (folate). The calibration analysis results indicated variation in the coefficients from -0.23 (sodium) to 1.00 (folate). Calibration produced satisfactory coefficients for the FFQ compared with the reference standard for energy, macronutrients, monounsaturated fat, cholesterol, vitamins B12/C, folate, sodium, iron, and calcium. CONCLUSIONS: After validating and calibrating tests, we observed that the FFQ was adequately accurate for assessing the food consumption of the pregnant women in this study.

Associations between Maternal Dietary Patterns and Infant Birth Weight in the NISAMI Cohort: A Structural Equation Modeling Analysis.

The mother's diet during pregnancy is associated with maternal and child health. However, there are few studies with moderation analysis on maternal dietary patterns and infant birth weight. We aim to analyse the association between dietary patterns during pregnancy and birth weight. A prospective cohort study was performed with pregnant women registered with the prenatal service (Bahia, Brazil). A food frequency questionnaire was used to evaluate dietary intake. Birth weight was measured by a prenatal service team. Statistical analyses were performed using factor analysis with a principal component extraction technique and structural equation modelling. The mean age of the pregnant women was 27 years old (SD: 5.5) and the mean birth weight was 3341.18 g. It was observed that alcohol consumption (p = 0.05) and weight-gain during pregnancy (p = 0.05) were associated with birth weight. Four patterns of dietary consumption were identified for each trimester of the pregnancy evaluated. Adherence to the "Meat, Eggs, Fried Snacks and Processed foods" dietary pattern (pattern 1) and the "Sugars and Sweets" dietary pattern (pattern 4) in the third trimester directly reduced birth weight, by 98.42 g (Confidence interval (CI) 95%: 24.26, 172.59) and 92.03 g (CI 95%: 39.88, 165.30), respectively. It was also observed that insufficient dietary consumption in the third trimester increases maternal complications during pregnancy, indirectly reducing birth weight by 145 g (CI 95%: -21.39, -211.45). Inadequate dietary intake in the third trimester appears to have negative results on birth weight, directly and indirectly, but more studies are needed to clarify these causal paths, especially investigations of the influence of the maternal dietary pattern on the infant gut microbiota and the impacts on perinatal outcomes.

An accuracy study of the clinical diagnosis of periodontitis in pregnant women.

BACKGROUND: There exists a diverse range of criteria used in epidemiological studies for the diagnosis of periodontitis. The results from these studies should be evaluated with consideration to the diagnostic criteria used, and this may account for differences between studies especially in some population groups such as pregnant females. The objective is to evaluate the diagnostic criteria used in a variety of epidemiologic studies of periodontitis in pregnant females. METHODS: An accuracy study with cross-sectional design was performed out from a database of 671 pregnant females, using six different sets of criteria for the diagnosis of periodontitis. Women were classified for periodontitis, as follows: Center for Disease Control and Prevention/American Academy of Periodontology (CDC/AAP, 2012 criterion), the gold standard, Gomes-Filho et al.(2018) criterion, Albandar et al.(2007) criterion, Bassani et al.(2007) criterion, López et al.(2002) criterion, and Nesse et al.(2008) criterion. For comparison amongst the gold standard and the other criteria, sensitivity, specificity, predictive values, and likelihood ratio were determined. RESULTS: The frequency of periodontitis ranged from 25.0% to 90.2%. The Bassani et al. (2007) criterion was found to be more sensitive among the studies, and thus more suitable for diagnostic screening studies. Gomes-Filho et al.(2018), Albandar et al. (2007), López et al. (2002), and Nesse et al. (2008) criteria were considered more specific, which makes them more useful for studies of periodontitis with the aim of using diagnosis for confirmation of disease. CONCLUSIONS: A variation in the occurrence of periodontitis was observed. The criterion must be chosen according to the research aims and population characteristics.

Maternal anemia and birth weight: A prospective cohort study.

OBJECTIVE: To investigate the association between maternal anemia and low/insufficient birth weight. DESIGN: A prospective cohort study of pregnant women who underwent prenatal care at the healthcare units in a municipality of northeast Brazil together with their newborn infants was carried out. The pregnant women were classified as having anemia when the hemoglobin level was below 11 g/dl. Infants who were born full term weighing less than 2500 grams were classified as low birth weight, and those weighing between 2500 and 2999 grams were classified as insufficient weight. The occurrence of maternal anemia and its association with birth weight was verified using crude and adjusted Relative Risk (RR) estimates with their corresponding 95% confidence intervals (95%CIs). RESULTS: The final sample was comprised of 622 women. Maternal anemia was considered a risk factor for low/insufficient birth weight, after adjusting the effect measurement for maternal age, family income, urinary infection, parity, alcoholic beverage consumption during pregnancy and gestational body mass index: RRadjusted = 1.38 [95% CI: 1.07 to 1.77]. CONCLUSIONS: Maternal anemia was associated with low/insufficient birth weight, representing a risk factor for the gestational outcomes studied.

Consumo alimentar de gestantes atendidasem Unidades de Saúde / Food consumption of pregnant women assisted in Health Units

A alimentação exerce função indispensável para a saúde das gestantes. Devido ao período intenso de metabolismofaz-se necessário um consumo alimentar saudável que favoreça o desenvolvimento de uma gestação adequada.Diante dessas informações, o objetivo deste estudo foi analisar a adequação dos grupos alimentares consumidos pelasgestantes atendidas em consultas de pré-natal nas unidades de Saúde de um município do Recôncavo da Bahia. Trata-sede um estudo transversal, envolvendo gestantes atendidas no serviço de pré-natal da rede pública do ano 2010, 2011 e2012. Foi utilizado questionário estruturado com informações, obstétricas e de saúde. Para avaliar o consumo alimentarutilizou-se o Questionário de Frequência de Consumo de Alimentos (QFCA). As porções dos grupos alimentares foramdeterminadas e em seguida analisadas segundo a pirâmide alimentar adaptada para população brasileira. Analisaramsetambém as características socioeconômicas da amostra. Foram entrevistadas 70 gestantes, com idade de 20 a 45anos. Destas, 75,8% eram casadas ou com união estável, 78,6% com nível médio de escolaridade, 36,2% apresentaramrenda familiar menor que um salário mínimo e 41,5% autodeclaram-se negras. Observou-se que as característicassocioeconômicas podem influenciar diretamente no consumo alimentar das gestantes. Na análise dos grupos alimentaresnotou-se consumo insuficiente de leguminosas, leite e produtos lácteos, e consumo excessivo do grupo de açúcares/doces e carnes e ovos. Observou-se consumo alimentar inadequado em termos qualitativos (grupos alimentares),não atendendo às necessidades específicas do ciclo gestacional, podendo implicar em risco nutricional para mãe e oconcepto.

Food plays essential role for the health of pregnant women. Due to the intense metabolism period, it is necessaryhealthy food consumption which ensures the development of an adequate pregnancy. Due to this information, the aimof this study is to analyze the adequacy of food groups consumed by pregnant women attending prenatal consultationsin the health units of the municipality Reconcavo in Bahia. It is a cross sectional study involving pregnant women inprenatal service of the public network over the years 2010, 2011 and 2012. It was used structured questionnaire withsocio-demographic information, obstetric and health. To assess food consumption it was used the Survey of FoodConsumption Frequency (FFQ). The portions of the food groups were determined then analyzed according to the foodpyramid adapted to the Brazilian population. It was also analyzed the socioeconomic characteristics of the sample. Theyinterviewed 70 pregnant women aged between 20 and 45 years. Among these women, 75.8% were married or in astable relationship, 78.6% with high school degree, 36.2% had family income lower than the minimum wage and 41.5%declare themselves as black. It was observed that the socioeconomic characteristics can influence directly on the diet ofpregnant women. In the analysis of food groups was noted insufficient intake of legumes, milk and dairy products, andexcessive consumption of the group of sugar/sweets and meats and eggs. There was inadequate food consumption interms of qualitative (food groups), not taking into account the specific needs of the gestational cycle, which may resultin nutritional risk to mother and fetus.

Consumo alimentar de gestantes atendidas em Unidades de Saúde / Food consumption of pregnant women assisted in Health Units

A alimentação exerce função indispensável para a saúde das gestantes. Devido ao período intenso de metabolismofaz-se necessário um consumo alimentar saudável que favoreça o desenvolvimento de uma gestação adequada.Diante dessas informações, o objetivo deste estudo foi analisar a adequação dos grupos alimentares consumidos pelasgestantes atendidas em consultas de pré-natal nas unidades de Saúde de um município do Recôncavo da Bahia. Trata-sede um estudo transversal, envolvendo gestantes atendidas no serviço de pré-natal da rede pública do ano 2010, 2011 e2012. Foi utilizado questionário estruturado com informações, obstétricas e de saúde. Para avaliar o consumo alimentarutilizou-se o Questionário de Frequência de Consumo de Alimentos (QFCA). As porções dos grupos alimentares foramdeterminadas e em seguida analisadas segundo a pirâmide alimentar adaptada para população brasileira. Analisaramsetambém as características socioeconômicas da amostra. Foram entrevistadas 70 gestantes, com idade de 20 a 45anos. Destas, 75,8% eram casadas ou com união estável, 78,6% com nível médio de escolaridade, 36,2% apresentaramrenda familiar menor que um salário mínimo e 41,5% autodeclaram-se negras. Observou-se que as característicassocioeconômicas podem influenciar diretamente no consumo alimentar das gestantes. Na análise dos grupos alimentaresnotou-se consumo insuficiente de leguminosas, leite e produtos lácteos, e consumo excessivo do grupo de açúcares/doces e carnes e ovos. Observou-se consumo alimentar inadequado em termos qualitativos (grupos alimentares),não atendendo às necessidades específicas do ciclo gestacional, podendo implicar em risco nutricional para mãe e oconcepto.(AU)

Food plays essential role for the health of pregnant women. Due to the intense metabolism period, it is necessaryhealthy food consumption which ensures the development of an adequate pregnancy. Due to this information, the aimof this study is to analyze the adequacy of food groups consumed by pregnant women attending prenatal consultationsin the health units of the municipality Reconcavo in Bahia. It is a cross sectional study involving pregnant women inprenatal service of the public network over the years 2010, 2011 and 2012. It was used structured questionnaire withsocio-demographic information, obstetric and health. To assess food consumption it was used the Survey of FoodConsumption Frequency (FFQ). The portions of the food groups were determined then analyzed according to the foodpyramid adapted to the Brazilian population. It was also analyzed the socioeconomic characteristics of the sample. Theyinterviewed 70 pregnant women aged between 20 and 45 years. Among these women, 75.8% were married or in astable relationship, 78.6% with high school degree, 36.2% had family income lower than the minimum wage and 41.5%declare themselves as black. It was observed that the socioeconomic characteristics can influence directly on the diet ofpregnant women. In the analysis of food groups was noted insufficient intake of legumes, milk and dairy products, andexcessive consumption of the group of sugar/sweets and meats and eggs. There was inadequate food consumption interms of qualitative (food groups), not taking into account the specific needs of the gestational cycle, which may resultin nutritional risk to mother and fetus.(AU)

Amamentação: conhecimento e prática de gestantes / Breast Feeding: knowledge and practice of pregnancy

O leite materno contribui positivamente para o crescimento e desenvolvimento da criança e apresenta vantagens imunológicas,psicológicas e nutricionais. Adicionalmente, leva a considerável redução na mortalidade infantil por todas ascausas e também é importante para a saúde da mulher. Considerando as informações apresentadas, o objetivo do presenteestudo foi identificar os conhecimentos e a prática do aleitamento materno de gestantes atendidas em unidades de saúdeem um município do Recôncavo Baiano. Estudo transversal, envolvendo gestantes atendidas em pré-natal em unidades desaúde em município do Recôncavo da Bahia, de Outubro de 2010 a Maio de 2011. Foram excluídas do estudo gestantescom HIV/AIDS ou que se recusaram a participar. Foi utilizado um questionário estruturado sobre aleitamento materno etécnica da mamada, contendo 34 questões, sendo 19 destinadas às multíparas, sobre a experiência prévia com amamentação.Foram entrevistadas 50 gestantes, sendo 68% primigestas. Cerca de 76% das mulheres consideraram que as criançasdeveriam mamar exclusivamente ao seio até os 6 meses, e 80% consideraram o leite materno forte. No que tange aosbenefícios do aleitamento materno para a saúde da mulher, 88% reconheceram a importância dessa prática e apontaramcomo principal benefício a redução do câncer de mama (68%). Apesar da maioria das mães apresentarem conhecimentosobre a importância do aleitamento materno, este ainda não é aplicado satisfatoriamente na prática da amamentação.Deve-se salientar a importância de ações de educação e apoio à amamentação desde o pré-natal até a fase de introduçãode novos alimentos para otimização da prática do aleitamento materno.(AU)

Breastfeeding contributes positively to the growth and development of children and presents advantages immunological,psychological and nutritional. Additionally, it leads to considerable reduction in mortality from all causes and is alsoimportant for women’s health. Considering the information presented, there is the objective of this study was to identifythe knowledge and practice of breast-feeding of pregnant women attending health facilities in one district of ReconcavoBaiano. It is a cross-sectional study involving pregnant women attending antenatal care in health facilities in the municipalityReconcavo of Bahia, October/2010 to May/2011. The study excluded women with HIV / AIDS or who refused toparticipate. We used a structured questionnaire on breastfeeding and breastfeeding technique, containing 34 questions,19 aimed at multiparous on previous experience with breastfeeding. We interviewed 50 pregnant women, 68% primiparous.About 76% of women felt that children should breastfeed exclusively breastfed until 6 months, and 80% consideredstrong breast milk. Regarding the benefits of breastfeeding for the health of women, 88% recognized the importance ofthis practice and pointed as the main benefit to reducing breast cancer (68%). Although most mothers present knowledgeabout the importance of breastfeeding, it is not yet satisfactorily applied in the practice of breastfeeding. Must stress theimportance of education initiatives and support breastfeeding from antenatal and even the phase of introduction of newfoods for optimal breastfeeding.(AU)

Amamentação: conhecimento e prática de gestantes / Breast Feeding: knowledge and practice of pregnancy

O leite materno contribui positivamente para o crescimento e desenvolvimento da criança e apresenta vantagens imunológicas,psicológicas e nutricionais. Adicionalmente, leva a considerável redução na mortalidade infantil por todas ascausas e também é importante para a saúde da mulher. Considerando as informações apresentadas, o objetivo do presenteestudo foi identificar os conhecimentos e a prática do aleitamento materno de gestantes atendidas em unidades de saúdeem um município do Recôncavo Baiano. Estudo transversal, envolvendo gestantes atendidas em pré-natal em unidades desaúde em município do Recôncavo da Bahia, de Outubro de 2010 a Maio de 2011. Foram excluídas do estudo gestantescom HIV/AIDS ou que se recusaram a participar. Foi utilizado um questionário estruturado sobre aleitamento materno etécnica da mamada, contendo 34 questões, sendo 19 destinadas às multíparas, sobre a experiência prévia com amamentação.Foram entrevistadas 50 gestantes, sendo 68% primigestas. Cerca de 76% das mulheres consideraram que as criançasdeveriam mamar exclusivamente ao seio até os 6 meses, e 80% consideraram o leite materno forte. No que tange aosbenefícios do aleitamento materno para a saúde da mulher, 88% reconheceram a importância dessa prática e apontaramcomo principal benefício a redução do câncer de mama (68%). Apesar da maioria das mães apresentarem conhecimentosobre a importância do aleitamento materno, este ainda não é aplicado satisfatoriamente na prática da amamentação.Deve-se salientar a importância de ações de educação e apoio à amamentação desde o pré-natal até a fase de introduçãode novos alimentos para otimização da prática do aleitamento materno.

Breastfeeding contributes positively to the growth and development of children and presents advantages immunological,psychological and nutritional. Additionally, it leads to considerable reduction in mortality from all causes and is alsoimportant for women’s health. Considering the information presented, there is the objective of this study was to identifythe knowledge and practice of breast-feeding of pregnant women attending health facilities in one district of ReconcavoBaiano. It is a cross-sectional study involving pregnant women attending antenatal care in health facilities in the municipalityReconcavo of Bahia, October/2010 to May/2011. The study excluded women with HIV / AIDS or who refused toparticipate. We used a structured questionnaire on breastfeeding and breastfeeding technique, containing 34 questions,19 aimed at multiparous on previous experience with breastfeeding. We interviewed 50 pregnant women, 68% primiparous.About 76% of women felt that children should breastfeed exclusively breastfed until 6 months, and 80% consideredstrong breast milk. Regarding the benefits of breastfeeding for the health of women, 88% recognized the importance ofthis practice and pointed as the main benefit to reducing breast cancer (68%). Although most mothers present knowledgeabout the importance of breastfeeding, it is not yet satisfactorily applied in the practice of breastfeeding. Must stress theimportance of education initiatives and support breastfeeding from antenatal and even the phase of introduction of newfoods for optimal breastfeeding.