Ganho de peso gestacional e fatores maternos associados à sua inadequação em adolescentes brasileiras / Gestational weight gain and maternal factors associated with its inadequacy in Brazilian adolescents

Introdução: O ganho de peso gestacional (GPG) é amplamente discutido na literatura por se configurar como um dos determinantes para os desfechos maternos e neonatais, no entanto, grande parte das investigações são voltadas predominantemente para mulheres adultas. Objetivo: Avaliar os fatores maternos associados ao GPG em adolescentes brasileiras oriundas do estudo "Nascer no Brasil: inquérito nacional sobre parto e nascimento". Métodos: Estudo transversal, de base hospitalar, no qual foram incluídas 3.904 adolescentes com gestação de feto único e idade gestacional (IG) ao nascimento ≥37 semanas. Construiu-se um modelo hierarquizado para buscar associação entre a variável dependente: inadequação do GPG, e as independentes: características sociodemográficas, assistenciais, obstétricas e comportamentais. Resultados: As chances de GPT insuficiente foram maiores para as adolescentes do Norte (OR=1,50, IC95%: 1,07 ­ 2,10) e Nordeste (OR=1,68, IC95%: 1,27 ­ 2,21). O trabalho remunerado elevou as chances de GPG insuficiente (IC95%: 1,15 ­ 2,39) e excessivo (IC95%: 1,01 ­ 1,86). O sobrepeso ou obesidade pré-gestacional foram associados ao GPT excessivo (OR=1,86, IC95%: 1,19 ­ 2,92 e OR= 3,06, IC95%: 2,10 ­ 4,45, respectivamente), bem como a IG ≥42 semanas (OR=2,23, IC95%: 1,03 ­ 4,81). Conclusão: Para além das discussões já bem embasadas na literatura acerca do estado nutricional pré-gestacional e seu impacto no GPG, os presentes achados possibilitam um olhar mais focado acerca de questões sociais, as quais possuem extrema relevância no GPG e precisam ser considerados na prática clínica e nas políticas públicas direcionadas às adolescentes.

Introduction: Gestational weight gain (GWG) is widely discussed in the literature as it is one of the determinants of maternal and neonatal outcomes, however, most investigations are predominantly focused on adult women. Objective: To evaluate maternal factors associated with GPG in Brazilian adolescents from the study "Born in Brazil: national survey on labor and birth". Methods: Cross-sectional, hospital-based study, which included 3,904 adolescents with a singleton pregnancy and gestational age (GA) at birth ≥37 weeks. A hierarchical model was constructed to seek association between the dependent variable: GPG inadequacy, and the independent variables: sociodemographic, care, obstetric and behavioral characteristics. Results: The chances of insufficient GPT were higher for adolescents from the North (OR=1.50, 95%CI: 1.07 ­ 2.10) and Northeast (OR=1.68, 95%CI: 1.27 ­ 2, 21). Paid work increased the chances of insufficient (95%CI: 1.15 ­ 2.39) and excessive (95%CI: 1.01 ­ 1.86) GPG. Pre-gestational overweight or obesity were associated with excessive GPT (OR=1.86, 95% CI: 1.19 ­ 2.92 and OR= 3.06, 95% CI: 2.10 ­ 4.45, respectively), as well as GA ≥42 weeks (OR=2.23, 95% CI: 1.03 ­ 4.81). Conclusion: In addition to the already well-founded discussions in the literature about the pre-pregnancy nutritional status and its impact on GPG, the present findings allow a more focused look at social issues, which are extremely relevant in GPG and need to be considered in practice. clinic and public policies aimed at adolescents.

Factors associated with infant formula supplementation in Brazilian hospitals: a cross-sectional study

Abstract Objective To analyze the factors associated with infant formula supplementation in newborns referred to rooming-in in Brazilian hospitals. Method Cross-sectional study with data from 14,531 postpartum women and newborns obtained from the "Birth in Brazil" survey, conducted in 2011-2012. The analysis used a logistic regression model with a hierarchical approach. Results In total, 21.2% newborns received infant formula during hospital stay. After adjustment, the following factors were associated with the use of infant formula: maternal age ≥ 35 years (OR = 1.51; IC95%:1.30-1.75), prenatal care in a private service (OR = 2,22; IC:1.72-2.85)/public and private service (OR = 1.67; IC:1.24-2.23), cesarean delivery (OR = 1.83; IC:1.41-2.38), multiple pregnancy (OR = 3.786; IC:2.02-7.06), non-breastfeeding in the delivery room (OR = 1.780; IC:1.43-2.21), birth in a private hospital (OR = 1.695; IC:1.02-2.79), prematurity (OR = 1.656; IC:1.32-2.06) and extremes of birth weight (< 2.500 g: OR = 2.084; IC: 1.585-2.741/ ≥4,000g: OR = 1.672; IC:1.31-2.11). Teenage age (OR = 0.651; IC:0.55-0.76), low maternal education (OR = 0.579; IC:0.43-0.77), multiparity (OR = 0.588; IC:0.510-0.678), and lower economic class (OR = 0.565; IC:0.41-0.76) significantly reduced the probability of using infant formula. Conclusions Of the associated factors, the authors highlight cesarean delivery and non-breastfeeding in the delivery room, showing that it is necessary to strengthen policies that encourage good practices during childbirth care in order to promote exclusive breastfeeding and protect mothers and newborns from all social classes against the misuse of infant formula.

Fatores associados à adequação do ganho de peso gestacional de adolescentes brasileiras / Factors associated with the adequacy of gestational weight gain among Brazilian teenagers

Resumo O objetivo deste artigo é avaliar a adequação do ganho de peso gestacional total (GPT) segundo características maternas de adolescentes brasileiras. Estudo transversal e de base hospitalar. Foram incluídos 3.904 adolescentes com gestação de feto único e idade gestacional (IG) ao nascimento ≥ 37 semanas. Foi construído um modelo hierarquizado para analisar as variáveis dependentes e a adequação do GPT e das independentes: características sociodemográficas, assistenciais, obstétricas e comportamentais. As chances de GPT insuficiente foram maiores para as adolescentes do Norte (OR = 1,50; IC95%: 1,07-2,10) e Nordeste (OR = 1,68; IC95%: 1,27-2,21). O trabalho remunerado elevou as chances de GPT insuficiente (IC95%: 1,15-2,39) e excessivo (IC95%: 1,01-1,86). O índice de massa corporal pré-gestacional de sobrepeso ou obesidade associou-se ao GPT excessivo (OR = 1,86; IC95%: 1,19-2,92 e OR = 3,06; IC95%: 2,10-4,45, respectivamente), bem como a IG ≥ 42 semanas (OR = 2,23; IC95%: 1,03-4,81). Residir nas regiões Norte e Nordeste aumentou as chances de as adolescentes apresentarem GPT insuficiente. Exercer trabalho remunerado esteve associado a maior chance de GPT excessivo e insuficiente. Além disso, o sobrepeso ou obesidade pré-gestacional e IG ≥ 42 semanas ampliaram as chances de GPT excessivo.

Abstract The scope of this article is to evaluate the adequacy of total gestational weight gain (GWG) according to maternal characteristics of Brazilian adolescents. It involved a cross-sectional, hospital-based study. A total of 3,904 teenagers with a single fetus gestation and gestational age (GA) at birth ≥ 37 weeks were included. A hierarchical model was built to analyze the dependent and independent variables adequacy of GWG: sociodemographic, care, obstetric and behavioral characteristics. The chances of insufficient GWG were higher for adolescents from the North (OR = 1.50, 95%CI: 1.07-2.10) and Northeast (OR = 1.68, 95%CI: 1.27-2.21). Paid work increased the chances of insufficient (95%CI: 1.15-2.39) and excessive (95%CI: 1.01-1.86) GWG. The pre-pregnancy body mass index of overweight or obese adolescents was associated with excessive GWG (OR = 1.86, 95%CI: 1.19-2.92 and OR = 3.06, 95%CI: 2.10-4.45, respectively), as well as GA ≥ 42 weeks (OR = 2.23, 95%CI: 1.03-4.81). Living in the North and Northeast regions increases the chances of adolescents having insufficient GWG. Having paid work was associated with a greater chance of excessive and insufficient GWG. Furthermore, pre-pregnancy excess weight or obesity and GA ≥ 42 weeks increased the chances of excessive GWG.