Improving breastfeeding among adolescent mothers: a prospective cohort

ABSTRACT BACKGROUND: Exclusive breastfeeding is recommended for the first six months, and mother's age impact early weaning. Educational support and relevant information can increase breastfeeding rates. OBJECTIVE: To determine whether antenatal education enhances the maintenance, intention, and confidence in breastfeeding among adolescents. DESIGN AND SETTING: A prospective cohort study involving primiparous adolescents who gave birth at the Woman's Hospital (CAISM), Universidade Estadual de Campinas, Brazil. METHODS: Adolescent mothers were categorized into two groups based on the location of prenatal care: those at the Woman's Hospital (WH) who received antenatal education, and at the Primary Care (PC) who did not receive antenatal education. All adolescents received breastfeeding orientation during their postpartum hospital stay. The groups were compared using the Student's t-test, Mann-Whitney U test, and chi-squared test. Log-binomial models were used to compare the groups at different time intervals. RESULTS: The study included 132 adolescents: 59 in the WH group and 73 in the PC group. Six months postpartum, adolescents in the WH group demonstrated higher engagement in breastfeeding (P < 0.005) and exclusive breastfeeding (P = 0.04) than PC group. PC group showed greater lack of confidence in breastfeeding (P = 0.02) and felt less prepared (P = 0.01). Notably, all WH adolescents reported a stronger desire to breastfeed after antenatal education. CONCLUSION: Antenatal education significantly improves the maintenance, intention, and confidence of breastfeeding among adolescents. This education approach can be implemented across all healthcare levels and should be made accessible to all women throughout the pregnancy and postpartum period.

The role of health-related behaviors in gestational weight gain among women with overweight and obesity: A cross-sectional analysis / Papel dos comportamentos relacionados à saúde no ganho de peso gestacional em mulheres com sobrepeso e obesidade: Um estudo transversal

Abstract Objective To evaluate the influence of health-related behaviors including food intake, physical activity, sleep time, smoking habits, stress, depression, and optimism on excessive gestational weight gain (GWG) among women with overweight and obesity. Methods A cross-sectional study was conducted at the Women's Hospital of the Universidade de Campinas, Campinas, state of São Paulo, Brazil, with 386 mediate postpartum women that fit the inclusion criteria of ≥ 19 years old, first prenatal care visit at or before 14 weeks, and single live baby. Dietary habits, physical exercise practice, sleep duration, smoking and alcohol habits were self-reported. Psychosocial history was evaluated using the Edinburgh Postpartum Depression Scale (EPDS), Perceived Stress Scale (PSS), and Life Orientation Test-Revised (LOT-R). Sociodemographic, obstetric, anthropometric, and neonatal data were retrieved from medical records. Descriptive statistics and stepwise logistic regression were performed. Results The prevalence of overweight and obesity was 29.27% and 24.61%, respectively, according to the body mass index (BMI). Excessive GWG was observed in 47.79% of women with overweight and in 45.26% of women with obesity. Excessive GWG among overweight and obese women was associated with inadequate vegetable and bean consumption (odds ratio [OR] = 2.95, 95% confidence interval [CI]: 1.35-6.46 and OR = 1.91; 95%CI: 1.01-3.63, respectively) and stress (OR = 1.63; 95%CI 1.01-2.64). After adjustment by maternal age, multiparity, sleep duration, smoking, and alcohol intake, we found that stress (PSS ≥ 20) was associated with excessive GWG in women with overweight or obesity (OR: 1.75; 95%CI: 1.03-2.96). Conclusion Among women with overweight and obesity, stress is the main variable associated with excessive GWG. Inadequate vegetables and beans consumption also showed association with excessive GWG.

Resumo Objetivo Avaliar a influência de comportamentos relacionados à saúde: ingestão alimentar, atividade física, tempo de sono, tabagismo, estresse, depressão e otimismo no ganho de peso gestacional (GPG) excessivo em mulheres com sobrepeso e obesidade. Métodos Estudo transversal no Hospital da Mulher, Universidade de Campinas, Campinas, SP, Brasil, com 386 mulheres no puerpério mediato, ≥ 19 anos, primeira consulta pré-natal até 14 semanas e cuja gestação resultou em neonato vivo. Os comportamentos relacionados à saúde foram autorreferidos. História psicossocial foi avaliada usando: Escala de Depressão Pós-Parto de Edimburgo (EPDS, na sigla em inglês), Escala de Estresse Percebido (PSS, na sigla em inglês) e Teste de Orientação à Vida-Revisado (LOT-R, na sigla em inglês). Dados sociodemográficos, obstétricos, antropométricos e neonatais foram obtidos dos prontuários médicos. Realizou-se análises descritivas e regressão logística. Resultados A prevalência de sobrepeso e obesidade foi de 29,27% e de 24,61%, respectivamente. Ganho de peso gestacional excessivo foi observado em 47,79% das mulheres com sobrepeso e em 45,26% das mulheres com obesidade. O consumo inadequado de verduras e feijão (razão de probabilidade [OR] = 2,95; índice de confiança [IC] 95%: 1,35-6,46 e OR = 1,91; IC95%: 1,01-3,63, respectivamente) e estresse (OR = 1,63; IC95%: 1,01-2,64) foram associados ao GPG excessivo em mulheres com sobrepeso e obesidade. Análises ajustadas para idade materna, multiparidade, duração do sono, tabagismo e ingestão de álcool mostraram que o estresse (PSS ≥ 20) associou-se ao GPG excessivo em mulheres com sobrepeso e obesidade (OR = 1.75; 95%CI: 1.03-2.96). Conclusão Entre mulheres com sobrepeso e obesidade, o estresse foi a principal variável associada ao GPG excessivo. O consumo inadequado de verduras e feijão também se associou com o GPG excessivo.

Putting knowledge into practice-the challenge of acquiring healthy habits during pregnancy colocando conhecimento em prática - o desafio de adquirir hábitos saudáveis durante a gravidez

Abstract Objective The aim of this study was to investigate the knowledge concerning gestational weight gain (GWG), nutrition, and physical exercise (PE) in pregnant women, and how to put them into practice. Methods A cross-sectional study with 61 pregnant women above 26 weeks of gestation, at the Woman's Hospital, CAISM, University of Campinas. Questionnaires regarding the knowledge of healthy habits (HH) during pregnancy, sociodemographic data, and previous obstetric outcomes were applied. An educational guide with advice on HH during pregnancy and in the postpartum period was offered. Results The average age of women was 28.7 ± 6.23 years, with 85% of them being married; 32% nulliparous; the average body mass index (BMI) before pregnancy was 25.4 ± 9.8 kg/m2, and themean number of years of schoolingwas 11.2 ± 3.8. Only 61%of the subjects had received any previous information about GWG during their antenatal care and were aware as to howmany pounds they should gain during pregnancy. Among the 61 women, 85% understood that they did not need to "eat for 2" and 99% knew that PE had benefits for their body and was safe for their baby. Half of the women practiced PE prior to pregnancy; however, only 31% continued the practice of PE during the pregnancy. Conclusion Despite understanding the need for HH during pregnancy, women still need encouragement to practice PE during pregnancy, as well as more information about GWG.

Resumo Objetivo O objetivo deste estudo foi investigar os conhecimentos sobre ganho de peso gestacional (GPG), nutrição, e exercício físico (EF) em gestantes e o quanto elas os colocam em prática. Métodos Estudo transversal realizado no Hospital da Mulher, CAISM, Unicamp, com 61 gestantes acima das 26 semanas gestacionais. Questionários sobre conhecimento de hábitos saudáveis (HS) durante a gestação, dados sociodemográficos, e antecedentes obstétricos foram aplicados. Um guia educacional com conselhos sobre HS durante a gravidez e período pós-parto foi oferecido. Resultados A idade média das mulheres foi de 28,7 ± 6,23 anos, sendo 85% casadas, 32% nulíparas, o índice de massa corporal (IMC) médio antes da gestação foi de 25,4 ± 9,8 kg/m2, e amédia de anos de escolaridade foi de 11,2 ± 3,8. Apenas 61% das mulheres entrevistadas haviam recebido informações prévias sobre o GPG durante o pré-natal e sabiam quantos quilos deveriam ganhar durante a gravidez. Entre as mulheres, 85% sabiam que não precisavam "comer por dois," e 99% sabiam que o EF tinha benefícios para seu corpo e era seguro para seu bebê. Metade das mulheres praticava EF antes da gravidez, mas apenas 31% continuaram praticando durante a gravidez. Conclusão Apesar de compreender a necessidade de HS durante a gravidez, as mulheres ainda precisam de incentivo para praticar EF durante a gravidez, bem como mais informações sobre o GPG.

Perfil nutricional e prevalência de anemia em gestantes adolescentes / Nutritional status and prevalence of anemia in pregnant adolescent

Objetivos: Avaliar o perfil nutricional no início do pré-natal e a associação entre anemia e resultados perinatais em gestantes adolescentes. Métodos: Esta dissertação aborda resultados de dois projetos de pesquisa distintos. Projeto 1: Corte transversal. Foram coletados dados sócios-demográficos, hábitos, comorbidades, hemoglobina sérica, tratamento para anemia, intercorrências da gestação, via de parto, e dados do recém-nascido de gestantes adolescente que tiveram pré-natal e parto no CAISM. A amostra foi dividida em: gestantes adolescentes sem anemia, com anemia tratada e com anemia sem tratamento. Frequências, médias, desvios-padrão e teste de Qui-quadrado foram calculados. Projeto 2: Corte transversal prospectivo. Foram coletados dados sociais demográficos, reprodutivos, dietéticos e antropométricos, de primigestas adolescentes, antes da 20a semana de gestação, através de questionário padronizado, Recordatório de 24 horas, Índice de Massa Corpórea (IMC) e percentagem de gordura corporal (%GC) por dobras cutâneas (DC) e análise da composição corporal por impedância bioelétrica (BIA). Utilizou-se teste de Qui-quadrado e teste exato de Fisher para as variáveis contínuas e teste de Correlação de Spearman para análise das variáveis dietéticas segundo variáveis antropométricas. Resultados: No primeiro estudo foram analisadas 458 gestantes, com prevalência de anemia de 41.27%, sendo 27.07% anemia leve, 13.97% anemia moderada e 0.22% anemia severa, destas 87.24% receberam tratamento. A idade média foi 16 anos, 81.03% primigestas. Os subgrupos de análise apresentaram características sociais demográficas, obstétricas e hábitos similares. Síndromes hipertensivas (5.75%), infecções do trato urinário (4.2%) e diabete (2.88%) ocorreram sem diferença entre os grupos. O HIV+ foi mais prevalente entre adolescentes com anemia não tratada (p=0.018). Trabalho de parto prematuro, Capurro<37 e óbito fetal apresentaram associação com anemia não tratada (p=0.003, p=0.036 e p=0.004 respectivamente). Taxa de cesariana de 36.9%, as principais indicações e médias de peso dos recém-nascidos foram similares entre os grupos. No segundo estudo foram incluídas 87 adolescentes com idade média de 15(±1.4) anos. IMC pré-gestacional médio de 22.9Kg/m² (±4.2) sendo, 13.8% baixo peso, 59.8% eutrófica, 18.4% sobrepeso e 8% obesa, e na primeira consulta de pré-natal IMC médio de 22.9 (±4.2), 4.6% baixo peso, 63.2% eutrófica, 20.7% sobrepeso e 11.5% obesas. A variação média de peso foi 1.7Kg(±4,4). A %GC média por DC e BIA foi 31.9% (±4.4) e 28.7% (±4.6), respectivamente, com forte correlação entre os dois métodos (r=0.77372). O consumo energético médio foi 116.8% (±67.2) da recomendação diária média (1805.5Kcal/dia; ±67.2). Consumo de carboidrato foi adequado em 24.1% das gestantes, lipídio em 34.5% e proteína em 72.4%. Cálcio foi consumido inadequadamente em 94.3% e zinco 62.1%, e ferro e ácido fólico ambos em 98.9% das gestantes. O consumo de proteína e zinco tiveram correlação negativa com a %GC por ambos os métodos (r=-0.3096 e r=-0.2363, respectivamente). Conclusões: As adolescentes apresentaram alta prevalência de anemia, que se não tratada aumentou a ocorrência de parto prematuro e óbito fetal. Adolescentes também apresentam IMC médio eutrófico, elevado %GC, baixa ingestão de micronutrientes cálcio, ferro e ácido fólico. A medida das dobras cutâneas e da BIA apresentaram boa correlação na avaliação da %GC. A adesão ao tratamento através de uma assistência de pré-natal multidisciplinar às gestantes adolescentes pode ser a chave para a redução de desfechos neonatais negativos associados a nutrição. (AU)

Objective: Evaluate the nutritional status in early pregnancy and the association between anemia and perinatal outcomes in pregnant adolescents. Methods: This master dissertation addresses results of two different research projects. Project 1: A cross-sectional study. Sociodemographic data, habits, comorbidities, serum hemoglobin, treatment for anemia, pregnancy complications, mode of delivery, and neonatal outcomes were collected. The sample was divided in three groups: pregnant adolescents without anemia, with treated anemia and with untreated anemia. Frequencies, means, standard deviations and Chi square test were calculated. Project 2: A prospective cross-sectional study. Sociodemographic, reproduction, dietetics and anthropometric data were collected from primiparous adolescents, before the 20th week of pregnancy, by standardized questionnaire, 24 hours recall, body mass index (BMI) and body fat percentage (%BF) by subcutaneous adiposity (SA) and body composition by bioelectrical impedance analysis (BIA). For continues variables Qui-square test and Fisher test were used and Spearman's Rank-Order Correlation test for dietetics variables analyses according to anthropometric variable. Results: In the first study were included 458 pregnant adolescents, with prevalence anemia of 41.27%. Mild, moderate or severe anemia was presented in 65.60%, 33.86% and 0.52%, respectively. The mean age was 16 years, 81.03% primiparous. Among pregnant adolescents with anemia, 87.24% received treatment with iron supplementation. The three groups show similar demographic social characteristics, obstetric and habits. Hypertensive syndromes (5.75%), urinary tract infection (4.2%) and diabetics (2.88%), were the most frequency maternal comorbidity, with no difference among the groups. Positive HIV was more prevalent in adolescents with non-treated anemia (p=0.018). Preterm labor (p=0.003), gestational birth age at <37 weeks (p=0.036) and stillbirth (p=0.004) shown association with non-treated anemia. The caesarean rate was 36.90%, and its main indications and mean weight of newborn were similar between groups. In the second study were included 87 adolescents with an average age of 15(±1.4) years. The pre-gestational BMI mean was of 22.9Kg/m² (±4.2), while other values were 13.8% low weight, 59.8% eutrophic, 18.4% overweight and 8% obese. At the first prenatal visit the values were 22.9(±4.2), 4.6% low weight, 63.2% eutrophic, 20.7% over eight and 11.5% obese. The mean weight variation was 1.7Kg (±4,4). The mean of %BF by SA and BIA were 31.9% (±4.4) and 28.7% (±4.6), respectively, with strong correlation in both methods (r=0.77372). The average energy consumption was 116.8% (±67.2) of the average daily recommendation (1805.5Kcal/dia; ±67.2). Carbohydrate was suitable in 24.1% of adolescents, lipid 34.5% and protein 72.4%. Calcium was inappropriately consumed in 94.3%, zinc in 62.1% and iron and folic acid, both in 98.9% of adolescents. Protein and zinc consumption had negative correlation with the %BF, by both methods (r=-0.3096 e r=-0.2363). Conclusion: High prevalence of anemia, which if left untreated increase the prevalence of preterm birth and stillbirth. The pregnant adolescents presented a eutrophic BMI, with high %BF, low consumption of calcium, iron and folic acid. The measure SA and BIA showed good correlation in the evaluation of %BF. Adherence to treatment by a multidisciplinary prenatal care for pregnant adolescents may be the key to reducing adverse neonatal outcomes associated with food.(AU)