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.

Putting Knowledge into Practice-The Challenge of Acquiring Healthy Habits during Pregnancy.

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 the mean number of years of schooling was 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 how many 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.

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 a média 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.

The misleading choice for safer births in Brazilian's most developed region: a cross-sectional study.

PURPOSE: To analyze the Cesarean Section (CS) rate in Brazilian women according to category of health insurance and individual characteristics associated with the mode of delivery. MATERIALS AND METHODS: A cross-sectional study was performed in three maternity services (one public tertiary referral center, one maternity service for both public and private care, and one private maternity service) in Campinas city, Brazil. Eligibility criteria were: inpatient during the immediate postpartum period, hospital birth, single pregnancy, and live newborn. Sociodemographic and anthropometric data, reproductive history, pregnancy planning, and prenatal care information was obtained from participants. Comorbidities, type of birth, and newborn data were collected from medical records. The mode of delivery was categorized as either CS or vaginal delivery. RESULTS: A total of 1276 women were included in this study. The overall CS rate was 57.5%. CS rates were 41.6, 54.8, and 90.1% for public, mixed (public and private), and private maternity services, respectively. Mean age was higher in women who had a CS (28.0 ± 6.0 years versus 25.9 ± 6.5 years, p < .0001) as was the mean Body Mass Index (25.2 ± 5.3 kg/m2 versus 23.8 ± 4.5 kg/m2, p < .0001). CS was related to higher education, employment, white skin color, planned pregnancy, antenatal care in a private service, and primiparity. CONCLUSIONS: The overall CS rate was high (greater than 50%); in the private service, almost all participants had a CS delivery (90.1%). Better socioeconomic conditions and primiparity were associated with higher CS rates in Brazil. Political pressure for the management of unnecessary CSs is vital in Brazil. Together with the provision of real incentives for normal deliveries in public and, most importantly, private services.

Body mass Index changes during pregnancy and perinatal outcomes - A cross-sectional study / Mudanças do índice de massa corporal na gravidez e resultados perinatais - um estudo transversal

Abstract Objective To evaluate the relation between changes the body mass index (BMI) percentile, reflected in the Atalah curve, and perinatal outcomes. Methods A cross-sectional study with 1,279 women was performed. Data regarding gestational weight, sociodemographic characteristics and perinatal outcomes were collected through medical charts, prenatal card and interviews in the postpartum period. Women could be classified according to the Atalah curve in the following categories: low weight, adequateweight, overweight, and obese. The BMIwas calculated at the first and at the last prenatal care visits, and these values were compared. Results An increase in the BMI category according to the Atalah classification occurred in 19.9% of pregnant women, and an increase of 3.4, 5.8 and 6.4 points of BMI were found for women respectively classified in the adequate weight, overweight and obese categories at the first prenatal visit. Women with high school education presented a lower chance of increasing their BMI (odds ratio [OR] 0:47 [0.24- 0.95]). Women who evolved with an increase in the the Atalah classification were associated with cesarean section (OR 1.97-2.28), fetalmacrosomia (OR 4.13-12.54) and large for gestational age newborn (OR 2.88-9.83). Conclusion Pregnant women who gained enough weight to move up in their BMI classification according to the Atalah curve had a higher chance of cesarean section and macrosomia. Women classified as obese, according to the Atalah curve, at the first prenatal visit had a high chance of cesarean section and delivering a large for gestational age newborn.

Resumo Objetivo Avaliar a relação entre mudanças no percentual do índice de massa corporal (IMC), refletidas na curva de Atalah, e resultados perinatais. Métodos Foi realizado um estudo transversal com 1.279 mulheres. Os dados sobre o peso na gestação, características sociodemográficas e resultados perinatais foram coletados através de prontuários, cartão pré-natal e entrevistas no pós-parto. As mulheres foramclassificadas de acordo coma curva de Atalah nas seguintes categorias: baixo peso, peso adequado, sobrepeso e obesidade. O IMC foi calculado na primeira e na última visita ao pré-natal e esses valores foram comparados. Resultados Houve aumento na categoria do IMC segundo a classificação de Atalah em 19,9% das mulheres grávidas e um aumento de 3,4; 5,8 e 6,4 pontos do IMC foram encontrados para mulheres respectivamente classificadas nas categorias peso adequado, sobrepeso e obesidade na primeira consulta pré-natal. As mulheres com educação secundária apresentaram menor chance de aumentar sua classificação de IMC (odds ratio [OR] 0:47 [0,24- 0,95]). As mulheres que evoluíram com o aumento na classificação de Atalah foramassociadas a cesariana (OR 1,97-2,28),macrossomia fetal (OR 4,13-12,54) e recém-nascido grande para a idade gestacional (OR 2,88-9,83). Conclusão Gestantes com ganho de peso excessivo, o suficiente para aumentar sua classificação do IMC segundo a curva de Atalah, tiverammaiores chances de cesariana e macrossomia. As mulheres classificadas como obesas na primeira visita pré-natal, de acordo com a curva de Atalah, tiveram uma grande chance de cesariana e recémnascido grande para a idade gestacional.

Body Mass Index Changes during Pregnancy and Perinatal Outcomes - A Cross-Sectional Study.

OBJECTIVE: To evaluate the relation between changes the body mass index (BMI) percentile, reflected in the Atalah curve, and perinatal outcomes. METHODS: A cross-sectional study with 1,279 women was performed. Data regarding gestational weight, sociodemographic characteristics and perinatal outcomes were collected through medical charts, prenatal card and interviews in the postpartum period. Women could be classified according to the Atalah curve in the following categories: low weight, adequate weight, overweight, and obese. The BMI was calculated at the first and at the last prenatal care visits, and these values were compared. RESULTS: An increase in the BMI category according to the Atalah classification occurred in 19.9% of pregnant women, and an increase of 3.4, 5.8 and 6.4 points of BMI were found for women respectively classified in the adequate weight, overweight and obese categories at the first prenatal visit. Women with high school education presented a lower chance of increasing their BMI (odds ratio [OR] 0:47 [0.24- 0.95]). Women who evolved with an increase in the the Atalah classification were associated with cesarean section (OR 1.97-2.28), fetal macrosomia (OR 4.13-12.54) and large for gestational age newborn (OR 2.88-9.83). CONCLUSION: Pregnant women who gained enough weight to move up in their BMI classification according to the Atalah curve had a higher chance of cesarean section and macrosomia. Women classified as obese, according to the Atalah curve, at the first prenatal visit had a high chance of cesarean section and delivering a large for gestational age newborn.

OBJETIVO: Avaliar a relação entre mudanças no percentual do índice de massa corporal (IMC), refletidas na curva de Atalah, e resultados perinatais. MéTODOS: Foi realizado um estudo transversal com 1.279 mulheres. Os dados sobre o peso na gestação, características sociodemográficas e resultados perinatais foram coletados através de prontuários, cartão pré-natal e entrevistas no pós-parto. As mulheres foram classificadas de acordo com a curva de Atalah nas seguintes categorias: baixo peso, peso adequado, sobrepeso e obesidade. O IMC foi calculado na primeira e na última visita ao pré-natal e esses valores foram comparados. RESULTADOS: Houve aumento na categoria do IMC segundo a classificação de Atalah em 19,9% das mulheres grávidas e um aumento de 3,4; 5,8 e 6,4 pontos do IMC foram encontrados para mulheres respectivamente classificadas nas categorias peso adequado, sobrepeso e obesidade na primeira consulta pré-natal. As mulheres com educação secundária apresentaram menor chance de aumentar sua classificação de IMC (odds ratio [OR] 0:47 [0,24- 0,95]). As mulheres que evoluíram com o aumento na classificação de Atalah foram associadas a cesariana (OR 1,97­2,28), macrossomia fetal (OR 4,13­12,54) e recém-nascido grande para a idade gestacional (OR 2,88­9,83). CONCLUSãO: Gestantes com ganho de peso excessivo, o suficiente para aumentar sua classificação do IMC segundo a curva de Atalah, tiveram maiores chances de cesariana e macrossomia. As mulheres classificadas como obesas na primeira visita pré-natal, de acordo com a curva de Atalah, tiveram uma grande chance de cesariana e recém-nascido grande para a idade gestacional.

Early menarche and teenager pregnancy as risk factors for morbid obesity among reproductive-age women: A case-control study.

OBJECTIVES: The aim of this study was to evaluate potential risk factors, including non-communicable diseases, for morbid obesity in women between 20 and 49 years of age. METHODS: We performed a case-control study with 110 morbidly obese women and 110 women with adequate weight who were matched by age and with a 1:1 case to control ratio. All women were between 20 to 49 years old and non-menopausal. Possible risk factors were evaluated through a self-report questionnaire assessing socio-demographic, obstetric and gynecological characteristics, presence of non-communicable diseases and habits. Multiple logistic regression was used to estimate the odds ratio with respective confidence intervals. RESULTS: Menarche under 12 years old, teenage pregnancy and lower educational level were shown to be risk factors for morbid obesity among women of reproductive age. Incidences of non-communicable diseases (diabetes, hypertension, dyslipidemia, liver disease, lung disease, thyroid dysfunction, and joint pain) were increased in women with morbid obesity. CONCLUSIONS: Early menarche, teenage pregnancy and low education level are risk factors for the occurrence of morbid obesity in women of reproductive age. Some non-communicable diseases were already more prevalent in women with morbid obesity even before 50 years of age.

Early menarche and teenager pregnancy as risk factors for morbid obesity among reproductive-age women: A case-control study

OBJECTIVES: The aim of this study was to evaluate potential risk factors, including non-communicable diseases, for morbid obesity in women between 20 and 49 years of age. METHODS: We performed a case-control study with 110 morbidly obese women and 110 women with adequate weight who were matched by age and with a 1:1 case to control ratio. All women were between 20 to 49 years old and non-menopausal. Possible risk factors were evaluated through a self-report questionnaire assessing socio-demographic, obstetric and gynecological characteristics, presence of non-communicable diseases and habits. Multiple logistic regression was used to estimate the odds ratio with respective confidence intervals. RESULTS: Menarche under 12 years old, teenage pregnancy and lower educational level were shown to be risk factors for morbid obesity among women of reproductive age. Incidences of non-communicable diseases (diabetes, hypertension, dyslipidemia, liver disease, lung disease, thyroid dysfunction, and joint pain) were increased in women with morbid obesity. CONCLUSIONS: Early menarche, teenage pregnancy and low education level are risk factors for the occurrence of morbid obesity in women of reproductive age. Some non-communicable diseases were already more prevalent in women with morbid obesity even before 50 years of age.