Gestational weight gain adequacy for favourable obstetric and neonatal outcomes: A nationwide hospital-based cohort gestational weight gain for favourable obstetric and neonatal outcomes.

BACKGROUND & AIMS: Most Brazilian women fail to gain weight within recommendations during pregnancy but current guidelines about gestational weight gain was based on North American population analysis. There are no standardized recommendations developed from Brazilian population data, which should be particularly analysed due to ethnic and sociodemographic characteristics. This study analyses the gestational weight gain of Brazilian women with favourable obstetric and neonatal outcomes according to the pre-pregnancy body mass index, considering maternal sociodemographic characteristics. METHODS: We analysed data from the Birth in Brazil: national survey into labour and birth study, a nationwide hospital-based cohort carried out in 266 Brazilian hospitals from February/2011 to July 2012, including adult pregnant women who have no chronic diseases and who have single foetal gestation, born alive and without malformation. Favourable obstetric and neonatal outcomes considered were gestational age at birth greater than or equal to 37 and less than 42 weeks, birthweight between 2500 g and 4000 g, and birthweight suitable for gestational age. Sociodemographic characteristics were obtained from medical records and interviews. Weight and height information was obtained from the prenatal card or self-reported. The pre-pregnancy BMI was classified in low weight, normal weight, overweight, obesity I, obesity II, and obesity III. For the missing cases on pre-pregnancy weight or height, body mass index was imputed by multiple imputation prediction model. Gestational weight gain was the difference between the last weight before delivery and the pre-pregnancy weight and was presented as mean and confidence interval, mean and standard deviation, and percentiles distribution (10th to 90th) for each pre-pregnancy body mass index, thus compared to Institute of Medicine recommendations. RESULTS: The analysis included 8184 Brazilian women. The gestational weight gain was lower in women with less favoured social conditions. The mean gestational weight gain according to pre-pregnancy body mass index was within the Institute of Medicine recommendations, except for women with overweight or obesity class I, who have the mean weight gain higher than upper limit of the Institute of Medicine range. Gestational weight gain decreased with an increase in the categories of body mass index; the mean (±standard deviation) were: 15.41 kg (±5.53), 13.54 kg (±4.97), 12.45 kg (±5.86), 9.38 kg (±6.31), 7.15 kg (±6.43), and 5.04 kg (±7.10), for low weight, normal weight, overweight, and obesity I, II and III, respectively. Women had favourable obstetric and neonatal outcomes gaining less, within or more than the recommendations with higher range of variation amongst obesity classes I, II, and III which do not have specific ranges stated in Institute of Medicine guidelines. CONCLUSION: Brazilian women had favourable obstetric and neonatal outcomes gaining less, within or more than the Institute of Medicine recommendations. We highlight the need of population-based high-quality research to investigate the optimal GWG recommendations for this population.

Gestational weight gain and adverse maternal outcomes in Brazilian women according to body mass index categories: An analysis of data from the Birth in Brazil survey.

BACKGROUND & AIMS: Monitoring gestational weight gain (GWG) is relevant for perinatal outcomes, especially in the context of increasing obesity and overweight in the female population. This study analyses the association between GWG in Brazilian women, according to different body mass index (BMI) categories, and different outcomes, including hypertensive disorders of pregnancy (HDP), gestational diabetes (GD) and caesarean section. METHODS: Data on women from all the major regions of Brazil with a single pregnancy of a gestational age of 28 weeks or more and information available for anthropometric evaluation were included in the Birth in Brazil survey. Adequacy of GWG was assessed according to the percentile distribution of GWG of women with favourable neonatal outcomes, with the median of the distribution referred to as 100% adequacy in the GWG evaluation. RESULTS: The study consisted of 18,953 women, 58.3% of whom were normal weight and 35.1% were overweight. The adequacy of GWG was better amongst the normal weight women (91.1%) and worse amongst those with class III obesity (46.0% with excessive GWG), with the latter showing the highest occurrence of adverse outcomes. Results of the multivariate logistic regression analysis revealed that weight gain above 200% of the median in the normal weight, overweight and obese women was positively associated with HDP and caesarean section, but not with GD. CONCLUSIONS: The proposed ranges of appropriate GWG associated with favourable neonatal outcomes based on the data from the Birth in Brazil survey proved good predictors of HDP and caesarean section amongst the women included in the study.

Pregestational excess weight and adverse maternal outcomes: a systematic review of previous studies in Brazil / Exceso de peso pregestacional y resultados maternos adversos: una revisión sistemática de estudios previos en Brasil

INTRODUCTION: obesity is increasing among women at reproductive age in Brazil. Excess body weight during pregnancy negatively impacts women's health. OBJECTIVES: to identify and analyze the publications that showed the effects of pregestational excess weight on pregnancy, delivery, and post-delivery in Brazilian women. METHODS: this systematic review was performed including studies that involve Brazilian pregnant women with adverse outcomes caused by pregestational excess weight. Search, selection, and reporting were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The study was conducted by manually searching and screening the databases LILACS, PubMed, Scopus, Cochrane, and Periodicos CAPES. The selected articles were evaluated according to the quality of evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE), and categorized as studies with high (A), moderate (B), low (C), or extremely low (D) evidence quality. RESULTS: a total of 1,582 studies were found, of which 39 were included for final reading and evaluation. Among these, 12.8 %, 69.2 %, and 18.0 % were classified as A, B, and C or D for evidence quality, respectively. Hypertensive disorders of pregnancy, caesarean section, excessive weight gain, and gestational diabetes mellitus were commonly associated with pregestational excess weight in Brazilian women. CONCLUSIONS: the negative effects of excess body weight during pregnancy reflect the need for effective public policies that can address the problem, focusing on interventions that promote the health of women at reproductive age

INTRODUCCIÓN: la obesidad está aumentando entre las mujeres en edad reproductiva en Brasil. El exceso de peso corporal durante el embarazo afecta negativamente a la salud de las mujeres. OBJETIVOS: identificar y analizar publicaciones que mostraran los efectos del exceso de peso pregestacional sobre el embarazo, el parto y el posparto en mujeres brasileñas. MÉTODOS: esta revisión sistemática incluye estudios de mujeres embarazadas brasileñas con resultados adversos causados por el exceso de peso pregestacional. La búsqueda, la selección y la presentación de los resultados se realizaron de acuerdo con el sistema Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). El estudio se realizó mediante la búsqueda manual y el cribado de las bases de datos LILACS, PubMed, Scopus, Cochrane y Periódicos CAPES. Los artículos seleccionados se evaluaron de acuerdo con la calidad de la evidencia utilizando el sistema Grading of Recommendations, Assessment, Development and Evaluation (GRADE), y se clasificaron como estudios de alta (A), moderada (B), baja (C) o extremadamente baja (D) calidad de la evidencia. RESULTADOS: se encontraron un total de 1582 estudios, de los cuales 39 se incluyeron para su lectura final y evaluación. Entre estos, el 12,8 %, 69,2 % y 18,0 % se clasificaron como A, B y C o D en cuanto a calidad de evidencia, respectivamente. Los trastornos hipertensivos del embarazo, la cesárea, el aumento de peso excesivo y la diabetes mellitus gestacional se asociaron comúnmente con el exceso de peso pregestacional en las mujeres brasileñas. CONCLUSIONES: los efectos negativos del exceso de peso corporal durante el embarazo reflejan la necesidad de políticas públicas efectivas que puedan abordar el problema, centrándose en intervenciones que promuevan la salud de las mujeres en edad reproductiva

Pregestational excess weight and adverse maternal outcomes: a systematic review of previous studies in Brazil.

INTRODUCTION: Introduction: obesity is increasing among women at reproductive age in Brazil. Excess body weight during pregnancy negatively impacts women's health. Objetives: to identify and analyze the publications that showed the effects of pregestational excess weight on pregnancy, delivery, and post-delivery in Brazilian women. Methods: this systematic review was performed including studies that involve Brazilian pregnant women with adverse outcomes caused by pregestational excess weight. Search, selection, and reporting were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The study was conducted by manually searching and screening the databases LILACS, PubMed, Scopus, Cochrane, and Periodicos CAPES. The selected articles were evaluated according to the quality of evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE), and categorized as studies with high (A), moderate (B), low (C), or extremely low (D) evidence quality. Results: a total of 1,582 studies were found, of which 39 were included for final reading and evaluation. Among these, 12.8%, 69.2%, and 18.0% were classified as A, B, and C or D for evidence quality, respectively. Hypertensive disorders of pregnancy, caesarean section, excessive weight gain, and gestational diabetes mellitus were commonly associated with pregestational excess weight in Brazilian women. Conclusions: the negative effects of excess body weight during pregnancy reflect the need for effective public policies that can address the problem, focusing on interventions that promote the health of women at reproductive age.

INTRODUCCIÓN: Introducción: la obesidad está aumentando entre las mujeres en edad reproductiva en Brasil. El exceso de peso corporal durante el embarazo afecta negativamente a la salud de las mujeres. Objetivos: identificar y analizar publicaciones que mostraran los efectos del exceso de peso pregestacional sobre el embarazo, el parto y el posparto en mujeres brasileñas. Métodos: esta revisión sistemática incluye estudios de mujeres embarazadas brasileñas con resultados adversos causados por el exceso de peso pregestacional. La búsqueda, la selección y la presentación de los resultados se realizaron de acuerdo con el sistema Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). El estudio se realizó mediante la búsqueda manual y el cribado de las bases de datos LILACS, PubMed, Scopus, Cochrane y Periódicos CAPES. Los artículos seleccionados se evaluaron de acuerdo con la calidad de la evidencia utilizando el sistema Grading of Recommendations, Assessment, Development and Evaluation (GRADE), y se clasificaron como estudios de alta (A), moderada (B), baja (C) o extremadamente baja (D) calidad de la evidencia. Resultados: se encontraron un total de 1582 estudios, de los cuales 39 se incluyeron para su lectura final y evaluación. Entre estos, el 12,8%, 69,2% y 18,0% se clasificaron como A, B y C o D en cuanto a calidad de evidencia, respectivamente. Los trastornos hipertensivos del embarazo, la cesárea, el aumento de peso excesivo y la diabetes mellitus gestacional se asociaron comúnmente con el exceso de peso pregestacional en las mujeres brasileñas. Conclusiones: los efectos negativos del exceso de peso corporal durante el embarazo reflejan la necesidad de políticas públicas efectivas que puedan abordar el problema, centrándose en intervenciones que promuevan la salud de las mujeres en edad reproductiva.

[Epidemiological and nutritional characteristics of pregnant HIV-infected women]. / Características epidemiológicas e nutricionais de gestantes vivendo com o HIV.

PURPOSE: To describe the epidemiological profile and nutritional status of pregnant women infected with human immunodeficiency virus (HIV) and its effect on the nutritional status of these women during pregnancy. METHODS: A retrospective cohort study was conducted on 121 pregnant women with HIV infection, single fetus pregnancies, who received prenatal care and delivered at a referral unit for HIV-infected pregnant women during the period from 1997 to 2007. Outcomes of the study were the initial and final nutritional status as measured by body mass index, weight gain, anemia (hemoglobin <11 g/dL) and low birth weight. Bivariate analysis investigated the association of these outcomes with socio-demographic, clinical-care and dietary characteristics. We estimated the relative risks (RR) with 95% confidence intervals (CI). RESULTS: At the beginning of pregnancy, 11.0% of the women were underweight, and in late pregnancy, the prevalence was 29.3%. Low educational level, urinary infection and worm infestation were associated with low gestational weight in late pregnancy. The percentage of insufficient weight gain was 47.5%, with well-nourished pregnant women (RR=3.3 95%CI 1.3-8.1) and women with no companion (RR=1.5 95%CI 1.1-2.2) having a higher risk for this outcome. The prevalences of overweight at the beginning and at the end of pregnancy were 26.8 and 29.4, respectively. There was a significant prevalence of anemia (61.0%). CONCLUSIONS: The high percentage of negative nutritional outcomes identified at this referral service with multidisciplinary care for pregnant women living with HIV reveals the need to establish more effective strategies to deal with the complex context of HIV.

Características epidemiológicas e nutricionais de gestantes vivendo com o HIV / Epidemiological and nutritional characteristics of pregnant HIV-infected women

OBJETIVO: Caracterizar o perfil epidemiológico e nutricional de gestantes com o vírus da imunodeficiência humana (HIV) e os efeitos dessa infecção sobre o estado nutricional dessas mulheres durante a gravidez. MÉTODOS: Foi feito um estudo de coorte retrospectivo onde foram incluídas 121 gestantes com diagnóstico de infecção pelo HIV, gestação de feto único, que frequentaram pré-natal e fizeram o parto em uma unidade de referência para gestantes vivendo com HIV, no período de 1997 a 2007. Desfechos do estudo foram o estado nutricional inicial e final, avaliado pelo índice de massa corporal, o ganho ponderal, a anemia (hemoglobina <11 g/dL) e o baixo peso ao nascer. A análise bivariada investigou associação desses desfechos com variáveis sociodemográficas, clínico-assistenciais e características dietéticas. Foram estimados os riscos relativos (RR) com respectivos intervalos de confiança (IC) de 95 por cento. RESULTADOS: No inicio da gravidez 11 por cento das gestantes estavam com baixo peso, e no final da gravidez, essa prevalência foi de 29,3 por cento. A baixa escolaridade, a infecção urinária e verminose estiveram associadas ao baixo peso gestacional final. O percentual de ganho ponderal insuficiente foi de 47,5 por cento, gestantes eutróficas (RR=3,3 IC95 por cento 1,3-8,1) e as gestantes sem companheiro (RR=1,5 IC95 por cento 1,1-2,2) apresentaram um risco maior para esse desfecho. A prevalência de sobrepeso no início e no final foi de 26,8 e 29,4, respectivamente. Observou-se importante prevalência de anemia (61 por cento). CONCLUSÕES: O elevado percentual de desfechos nutricionais desfavoráveis identificados neste serviço de referência com assistência multiprofissional para gestantes que vivem com HIV revela a necessidade de se estabelecer estratégias mais eficientes para lidar com complexo contexto que envolve a ocorrência do HIV, principalmente para aquelas gestantes de baixo nível socioeconômico, que não tem união estável.

PURPOSE: To describe the epidemiological profile and nutritional status of pregnant women infected with human immunodeficiency virus (HIV) and its effect on the nutritional status of these women during pregnancy. METHODS: A retrospective cohort study was conducted on 121 pregnant women with HIV infection, single fetus pregnancies, who received prenatal care and delivered at a referral unit for HIV-infected pregnant women during the period from 1997 to 2007. Outcomes of the study were the initial and final nutritional status as measured by body mass index, weight gain, anemia (hemoglobin <11 g/dL) and low birth weight. Bivariate analysis investigated the association of these outcomes with socio-demographic, clinical-care and dietary characteristics. We estimated the relative risks (RR) with 95 percent confidence intervals (CI). RESULTS: At the beginning of pregnancy, 11.0 percent of the women were underweight, and in late pregnancy, the prevalence was 29.3 percent. Low educational level, urinary infection and worm infestation were associated with low gestational weight in late pregnancy. The percentage of insufficient weight gain was 47.5 percent, with well-nourished pregnant women (RR=3.3 95 percentCI 1.3-8.1) and women with no companion (RR=1.5 95 percentCI 1.1-2.2) having a higher risk for this outcome. The prevalences of overweight at the beginning and at the end of pregnancy were 26.8 and 29.4, respectively. There was a significant prevalence of anemia (61.0 percent). CONCLUSIONS: The high percentage of negative nutritional outcomes identified at this referral service with multidisciplinary care for pregnant women living with HIV reveals the need to establish more effective strategies to deal with the complex context of HIV.