Patient Health Questionnaire-9 versus Edinburgh Postnatal Depression Scale in screening for major depressive episodes: a cross-sectional population-based study.

BACKGROUND: Major depressive episodes (MDE) are frequent at the population level and are generally associated with severe symptoms that impair performance of activities of daily living of individuals suffering from this condition. The aim of this study was to compare the accuracy of two tests that separately showed suitable properties in screening for MDE: the Patient Health Questionnaire-9 (PHQ-9) and the Edinburgh Postnatal Depression Scale (EPDS). METHODS: In a previous study, the sensitivity and specificity of the PHQ-9 and the EPDS in screening for MDE were compared with a structured diagnostic interview conducted by psychiatrics and psychologists using the Mini International Neuropsychiatric Interview as the gold standard. In a sample of adults living in the community in Pelotas, Brazil, the PHQ-9 and EPDS were applied at the same interview and the gold standard on a median of 17 days later. The interviews were carried out at the participant's home. RESULTS: 447 Individuals (191 men and 256 women) were assessed. The PHQ-9 and the EPDS results were concordant in 87.5% of the respondents, with a moderate agreement beyond what was expected by chance alone (kappa = 0.61). The areas below the ROC curves were not statistically different (82.1% for PHQ-9 and 83.5% for EPDS) (p = 0.291), thus indicating that the two tests had similar moderate accuracy. CONCLUSIONS: PHQ-9 and EPDS may be applied with equal confidence in screening for MDE in the community.

Patient health questionnaire-9 versus Edinburgh postnatal depression scale in screening for major depressive episodes: a cross-sectional population-based study.

BACKGROUND: Major depressive episodes (MDE) are frequent at the population level and are generally associated with severe symptoms that impair performance of activities of daily living of individuals suffering from this condition. The aim of this study was to compare the accuracy of two tests that separately showed suitable properties in screening for MDE: the Patient Health Questionnaire-9 (PHQ-9) and the Edinburgh postnatal depression scale (EPDS). METHODS: In a previous study, the sensitivity and specificity of the PHQ-9 and the EPDS in screening for MDE were compared with a structured diagnostic interview conducted by psychiatrics and psychologists using the Mini International Neuropsychiatric Interview as the gold standard. In a sample of adults living in the community in Pelotas, Brazil, the PHQ-9 and EPDS were applied at the same interview and the gold standard on a median of 17 days later. The interviews were carried out at the participant's home. RESULTS: 447 individuals (191 men and 256 women) were assessed. The PHQ-9 and the EPDS results were concordant in 87.5 % of the respondents, with a moderate agreement beyond what was expected by chance alone (kappa = 0.61). The areas below the ROC curves were not statistically different (82.1 % for PHQ-9 and 83.5 % for EPDS) (p = 0.291), thus indicating that the two tests had similar moderate accuracy. CONCLUSIONS: PHQ-9 and EPDS may be applied with equal confidence in screening for MDE in the community.

Achados comportamentais e cognitivos em crianças de 5 a 11 anos nascidas com baixo peso / Behavioral and cognitive fi ndings in 5-11-year-old children born underweight

Introdução: O número de nascimentos prematuros cresceu nos últimos anos, aumentando a morbimortalidade infantil. Sabe-se que estes estão mais sujeitos a problemas futuros, devido à pouca maturidade de órgãos e ao baixo peso ao nascer. Contudo, a interação do indivíduo com o ambiente familiar e social também influencia no desenvolvimento e comportamento. O estudo avaliou crianças entre cinco e 11 anos de idade em acompanhamento no ambulatório de Pediatria da Faculdade de Medicina da Universidade Federal de Pelotas nascidas prematuras ou com baixo peso ao nascer e avaliou o perfil cognitivo e comportamental. Método: Participaram do estudo 47 crianças, sendo 11 prematuras e 36 nascidas a termo. Os instrumentos de avaliação utilizados foram: uma escala de Avaliação de Sintomas de Transtorno de Déficit de Atenção e Hiperatividade, o MTA SNAP-IV e o Questionário de Habilidades e Dificuldades (SDQ). Para avaliação econômica, utilizou-se o Critério de Classificação Econômica Brasil ­ ABEP. Utilizou-se ainda o teste das matrizes progressivas de Raven para estimar o quociente intelectual e um questionário com dados do histórico da criança, gestação e antecedentes dos pais. Resultados: Foi observada diferença estatisticamente significativa entre crianças a termo e prematuras, no sintoma impulsividade e e nos sintomas de transtorno de conduta, além de uma maior pontuação nos sintomas psiquiátricos em geral. Conclusão: Os achados sugerem que crianças prematuras apresentam maior prevalência de problemas de comportamento do que as nascidas a termo (AU)

Introduction: The number of preterm births has grown in recent years, increasing infant morbidity and mortality rates. It is known that preterm infants are more prone to future problems due to low maturity of organs and low birth weight. However, the interaction of the individual with the family and social environment also influences the development and behavior. This study assessed the cognitive and behavioral characteristics of children with low weight between 5 and 11 years as pediatric outpatients cared for in the School of Medicine, Federal University of Pelotas. Method: The study included 47 children, 11 preterm and 36 term born. The assessment instruments used were the MTA SNAP-IV ­ Assessment Scale of Symptoms of Attention Deficit Hyperactivity Disorder (ADHD) and the Skills and Difficulties Questionnaire (SDQ). For socioeconomic evaluation, we followed the Economic Classification Criterion Brazil ­ ABEP. We also used Raven's Progressive Matrices and a questionnaire with the child's historical data, gestation, and parental background. Results: A statistical difference between preterm and full-term children was observed in the symptom impulsivity and conduct disorders as well as a higher score in psychiatric symptoms in general. Conclusion: The findings suggest that preterm infants have a higher prevalence of behavior problems than those born at term (AU)

Dietary patterns during pregnancy and the association with sociodemographic characteristics among women attending general practices in southern Brazil: the ECCAGe Study.

The assessment of the relationship between food intake and sociodemographic factors is crucial for developing effective public health policies. The present study aimed to examine dietary patterns in pregnant women and the association between these patterns and sociodemographic characteristics. Pregnant women attending general practices in southern Brazil (n = 712) answered a questionnaire and a food-frequency questionnaire with 88 items. Three dietary patterns were identified using cluster analysis. The association between the dietary patterns and sociodemographic variables was analyzed using the chi-square test and adjusted standardized residuals (p < 0,05). The restricted pattern was associated with lower maternal age, not living with a partner and being a non-working student. The varied pattern was associated with older maternal age, living with a partner, being employed and higher levels of education and income. The common-Brazilian dietary pattern included traditional Brazilian food items and was associated with lower levels of education and income, being unemployed and being a non-student.

Healthy eating index for pregnancy: adaptation for use in pregnant women in Brazil.

OBJECTIVE: To evaluate dietary quality in a sample of pregnant women based on one simple and objective parameter. METHODS: Pregnant women (n = 712), between 16 and 36 weeks, attending primary care clinics in Porto Alegre and Bento Gonçalves, Southern Brazil, in 2010 were recruited to take part. The Healthy Eating Index for Brazilian Pregnancy (HEIP-B) was created, derived from the American instrument called Alternate Healthy Eating Index for Pregnancy (AHEI-P). Questionnaires on frequency of consumption and on socio-demographic factors were completed. Focused principal component analysis (ACPF) was used to assess the relationship between the index and nutrients relevant to pregnancy. RESULTS: The median (interquartile range) of AHEI-P and HEIP-B were 66.6 (57.8-72.4) and 67.4 (60.0-73.4), respectively. The HEIP-B showed a good positive correlation with nutrients which are specifically recommended for pregnancy: folate (r = 0.8; p < 0.001), calcium (r = 0.6; p < 0.001) and iron (r = 0.7; p < 0.001). CONCLUSIONS: The quality of the diet of the pregnant women in this study was classified as within the "improvements needed" cut off point, which demonstrates the need for more specific education on nutrition for this stage of life. The index showed good correlations and, thus, may be considered an effective tool for assessing the quality of nutrition during pregnancy.

Dietary patterns during pregnancy and the association with sociodemographic characteristics among women attending general practices in southern Brazil: the ECCAGe Study / Padrões alimentares na gestação e associação com características sociodemográficas em mulheres atendidas em unidades básicas de saúde no Sul do Brasil: Estudo ECCAGe / Padrones alimentarios en la gestación y su asociación con características sociodemográficas en mujeres atendidas en unidades básicas de salud en el sur de Brasil: estudio ECCAGe

The assessment of the relationship between food intake and sociodemographic factors is crucial for developing effective public health policies. The present study aimed to examine dietary patterns in pregnant women and the association between these patterns and sociodemographic characteristics. Pregnant women attending general practices in southern Brazil (n = 712) answered a questionnaire and a food-frequency questionnaire with 88 items. Three dietary patterns were identified using cluster analysis. The association between the dietary patterns and sociodemographic variables was analyzed using the chi-square test and adjusted standardized residuals (p < 0,05). The restricted pattern was associated with lower maternal age, not living with a partner and being a non-working student. The varied pattern was associated with older maternal age, living with a partner, being employed and higher levels of education and income. The common-Brazilian dietary pattern included traditional Brazilian food items and was associated with lower levels of education and income, being unemployed and being a non-student.

A avaliação do consumo alimentar e das condições sociodemográficas é crucial para o desenvolvimento de políticas públicas. Este estudo examinou os padrões alimentares em gestantes e sua associação com características sociodemográficas. Gestantes (n = 712) atendidas em unidades básicas de saúde no sul do Brasil, responderam a um questionário sobre as características sociodemográficas e a um outro de frequência alimentar. Foram identificados três padrões alimentares por análise de cluster. Utilizando-se o teste qui-quadrado com resíduos ajustado verificou-se a associação dos padrões alimentares com as variáveis sociodemográficas (p < 0,05). O padrão restrito foi associado com gestantes mais jovens, que não moram com o companheiro e só estudam; o padrão variado com mulheres mais velhas que moram com o companheiro, trabalham e têm níveis de escolaridade e renda mais altos. Mulheres que não trabalham nem estudam e possuem níveis de renda e escolaridade mais baixos estiveram associadas ao padrão comum-brasileiro, caracterizado por alimentos tradicionais da população brasileira.

La evaluación del consumo alimentario y de las condiciones sociodemográficas es crucial para el desarrollo de políticas públicas. Este estudio examinó padrones alimentarios en gestantes y su asociación con características sociodemográficas. Las gestantes (n = 712) atendidas en unidades básicas de salud en el sur de Brasil, respondieron a un cuestionario sobre características sociodemográficas y a un cuestionario de frecuencia alimentaria. Se identificaron tres padrones alimentarios por análisis de clúster. A través del test chi-cuadrado ajustado con residuos se verificó la asociación de los padrones alimentarios con las variables sociodemográficas (p < 0,05). El padrón restringido fue asociado con gestantes más jóvenes, que no viven con un compañero y sólo estudian; el padrón variado con mujeres más viejas, que viven con compañero, trabajan y tienen niveles de escolaridad y renta más altos. Mujeres que no trabajan ni estudian, y poseen niveles de renta y escolaridad más bajos, estuvieron asociadas al padrón común-brasileño, caracterizado por alimentos tradicionales de la población brasileña.

Índice de alimentação saudável para gestantes: adaptação para uso em gestantes brasileiras / Healthy eating index for pregnancy: adaptation for use in pregnant women in Brazil / Índice de alimentación saludable para gestantes: adaptación para uso en gestantes brasileñas

OBJETIVO: Avaliar a qualidade global da dieta em uma amostra de gestantes, a partir de um parâmetro único, simples e objetivo. MÉTODOS: Gestantes entre a 16ª e 36ª semana de gestação (n = 712) foram arroladas em unidades básicas de saúde em Porto Alegre e Bento Gonçalves, RS, em 2010. Com base no índice americano Alternate Healthy Eating Index for Pregnancy (AHEI-P) foi criado o Índice de Alimentação Saudável para Gestantes Brasileiras (HEIP-B). Foram aplicados o questionário de frequência alimentar e o questionário sociodemográfico. Foi utilizada a análise de componentes principais focada para avaliar a relação entre os índices e os nutrientes relevantes à gestação. RESULTADOS: A mediana e o intervalo interquartílico dos índices AHEI-P e HEIP-B foram 66,6 (57,8-72,4) e 67,4 (60,0-73,4), respectivamente. O HEIP-B mostrou boa correlação positiva com os nutrientes que têm recomendação específica no período gestacional folato (r = 0,8; p < 0,001), cálcio (r = 0,6; p < 0,001) e ferro (r = 0,7; p < 0,001). CONCLUSÕES: A qualidade da dieta das gestantes do presente estudo foi classificada dentro do ponto de corte "precisando de melhorias", o que mostra a necessidade de se trabalhar mais especificamente com educação alimentar nesse ciclo da vida. O índice aplicado mostrou boas correlações e, portanto, pode ser considerado um bom instrumento de avaliação da qualidade da alimentação durante a gestação.

OBJECTIVE: To evaluate dietary quality in a sample of pregnant women based on one simple and objective parameter. METHODS: Pregnant women (n = 712), between 16 and 36 weeks, attending primary care clinics in Porto Alegre and Bento Gonçalves, Southern Brazil, in 2010 were recruited to take part. The Healthy Eating Index for Brazilian Pregnancy (HEIP-B) was created, derived from the American instrument called Alternate Healthy Eating Index for Pregnancy (AHEI-P). Questionnaires on frequency of consumption and on socio-demographic factors were completed. Focused principal component analysis (ACPF) was used to assess the relationship between the index and nutrients relevant to pregnancy. RESULTS: The median (interquartile range) of AHEI-P and HEIP-B were 66.6 (57.8-72.4) and 67.4 (60.0-73.4), respectively. The HEIP-B showed a good positive correlation with nutrients which are specifically recommended for pregnancy: folate (r = 0.8; p < 0.001), calcium (r = 0.6; p < 0.001) and iron (r = 0.7; p < 0.001). CONCLUSIONS: The quality of the diet of the pregnant women in this study was classified as within the "improvements needed" cut off point, which demonstrates the need for more specific education on nutrition for this stage of life. The index showed good correlations and, thus, may be considered an effective tool for assessing the quality of nutrition during pregnancy.

OBJETIVO: Evaluar la calidad global de la dieta en una muestra de gestantes, a partir de um parámetro único, simple y objetivo. MÉTODOS: Gestantes entre 16ª y 36ª semana de gestación (n=712) fueron inventariadas en unidades básicas de salud en Porto Alegre y Bento Gonçalves, RS, Brasil, en 2010. Con base en el índice americano Alternate Healthy Eating Index for Pregnancy (AHEI-P) se creó en índice de Alimentación Saludable para Gestantes (HEIP-B). Se aplicaron el cuestionario de frecuencia alimentaria y el cuestionario sociodemográfico. Se utilizó el análisis de componentes principales para evaluar la relación entre los índices y los nutrientes relevantes para la gestación. RESULTADOS: La mediana y el intervalo intercuartil de los índices AHEI-P y HEIP-B fueron 66,6 (57,8-72,4) y 67,4 (60,0-73,4), respectivamente. El HEIP-B mostró buena correlación positiva con los nutrientes que tienen recomendación específica en el período gestacional folato (r = 0,8; p < 0,001), calcio (r = 0,6; p < 0,001) e hierro (r = 0,7; p < 0,001). CONCLUSIONES: La calidad de la dieta de las gestantes del presente estudio fue clasificada dentro del punto de corte "precisando de mejorías", lo que muestra la necesidad de trabajar más específicamente con educación alimentaria en ese ciclo de la vida. El índice aplicado mostró buenas correlaciones y, por tanto, puede ser considerado un buen instrumento de evaluación de la calidad de la alimentación durante la gestación.

Abuse against women, depression, and infant morbidity: a primary care cohort study in Brazil.

BACKGROUND: The relationship between abuse against women and maternal depression as risk factors for infant morbidity is unclear. PURPOSE: To describe the association of prenatal and postnatal abuse against women on infant physical morbidity and examine the potential mediating effect of maternal depression on these associations. METHODS: Prospective cohort study of 375 women from pregnancy (16th-36th week) to the fifth month postpartum, who attended 18 primary care units in Southern Brazil between 2006 and 2008. Abuse and depression were measured at the prenatal and postnatal interviews using standardized instruments. Infant outcomes were diarrhea and respiratory infection during the first 5 months after birth. Analyses were conducted in 2010. RESULTS: Overall, 35% of participants reported having suffered abuse during pregnancy and/or in the postnatal period. In addition, 10.1% reported infant diarrhea and 20.5% respiratory infection. Infants of mothers abused at the postnatal period were at increased risk for diarrhea (adjusted relative risk [RR]=2.20, 95% CI=1.15, 4.19) and for respiratory infection (adjusted RR=1.68, 95% CI=1.12, 2.52). There was no mediating effect of depression for either outcome. CONCLUSIONS: Postnatal abuse against women is associated with risk of infant diarrhea and respiratory infection. The current findings highlight the importance of getting abuse against women into the public health agenda.

A bidimensional solution for outcomes in bipolar disorder.

Although depressive symptoms have been consistently associated with lower quality of life and increased disability in bipolar disorder, their relation to manic symptoms is not as clear cut. A great overlap between these outcomes complicates the understanding of how they cluster together. We used exploratory factor analysis to clarify the relation between these constructs. We consecutively recruited 320 patients with bipolar disorder, and interviewers rated the Hamilton Depression and Anxiety Rating Scales, the Young Mania Rating Scale (YMRS), Clinical Global Impression (CGI), and the Global Assessment of Functioning (GAF). The self-rated Sheehan Disability Scale and the World Health Organization Quality of Life-BREF questionnaires were also collected. Two distinct and large dimensions emerged. Depression and anxiety, along with the self-rated scales, loaded in the first factor, whereas the YMRS, the GAF, and the CGI loaded in the second. These findings imply that evaluating self- and observer-rated outcomes may make up for a more thorough evaluation because each conveys unique illness information.

Underdetection of psychiatric disorders during prenatal care: a survey of adolescents in Sao Paulo, Brazil.

PURPOSE: This study estimates the prevalence of common mental disorders and the proportion and potential determinants of detection among adolescents attending prenatal care. METHODS: We recruited 930 consecutive adolescents admitted for obstetric care, of which 457 participants had attended the hospital's prenatal care unit. Common mental disorders were assessed using the Composite International Diagnostic Interview (version 2.1). A detailed review of prenatal care records was used to identify detection of psychiatric disorders by prenatal healthcare professionals. RESULTS: A total of 103 adolescents (22.5%) had some mental disorder but only one-fifth of them had had their psychiatric disorder detected during prenatal care. The most frequent diagnosis using the Composite International Diagnostic Interview (version 2.1) was depression (13.5% or 62), but only 21% had been detected. Alcohol and drug dependence were the least common mental disorders (2.4%), but they were the most commonly detected (45.5%). Physical chronic condition increased the likelihood of detecting psychiatric disorder. CONCLUSION: Mental health is not yet recognized as an integral component of practice in prenatal care. Given the potential effect of antenatal psychiatric morbidity on maternal and child outcomes, especially among adolescents, practice needs to be changed and prenatal care professionals trained in the recognition and basic treatment of common mental disorders.

Underdetection of Psychiatric Disorders During Prenatal Care: a survey of adolescents in São Paulo, Brazil

Purpose: This study estimetes the prevalecence of common mental disorders and the proportion and potential determinants of detection among adolescents attending prenatal care. Methods: We recruited 930 consecutive adolescens admitted for obstetric care, of which 457 participants had attended the hospital's prenatal care unit. Common mental disorders were assessed using the Composite International Diagnostic INterview (version 2.1). A detailed review od prenatal care records was used to identify detection of psychiatric disorders by orenatal healthcare professionals. Results: A total of 103 adolescents(22.5%) had some mental disorder but only one-fifth of them had had their psychiatric disorder detected during prenatal care. The most frequent diagnosis using the Compsite Internaional Diagnostic Interview (version2.1). was depression (13.5%), but only 21% had been detected. Alcohol and drug dependence were the least common mental disorders (2.4%), but they were the most commoly detected (45.5%), Physical chronic condition increased the likelihood of detecting psychiatric disorder. Conclusion: Mental health is not yet recognized as an integral component of practice in prenatal care, Given the potential effect of antenatal psychiatric morbidity on maternal and child outcomesm especially among aodlescents, practice needs to be changed and prenatal care professionals trained in the recognition and basic treatment of common mental disorders.(AU)

Violence during pregnancy and newborn outcomes: a cohort study in a disadvantaged population in Brazil.

BACKGROUND: Violence against pregnant women is an increasing public health concern. The purpose of this study is to estimate the prevalence of violence during pregnancy, to identify characteristics associated and to assess the impact of violence on newborn outcomes. METHODS: Prospective cohort study of 652 pregnant women attending primary care clinics in Southern Brazil, from June 2006 to September 2007. Women with gestational age ranging from 16th and 36th were enrolled and their exposure to violence and mental disorder was assessed. After the birth they were contacted by telephone when information on obstetric and neonatal outcomes was obtained. RESULTS: Any violence during current pregnancy was reported by 18.3% [95% confidence interval (CI) 15.3-21.4%] participants, 15.0% (95% CI 12.3-17.8%) psychological violence, 6% (95% CI 4.2-7.8%) physical violence and 3% (0-0.5%) sexual violence. These women were more often of low income, did not work or study and had inadequate prenatal care and pregnancy weight gain. There was a statistically significant crude association between exposure to physical and psychological violence [relative risk (RR) 3.21 (1.51-6.80)]. After adjustment for family income, number of prenatal visits, length of gestation and gestational weight gain, the effect size decreased, but remained statistically significant (RR 2.18; 95% CI 1.16-4.08%). CONCLUSION: In disadvantaged settings in Brazil, violence in pregnancy is frequent; it is associated with inadequate maternal weight gain during pregnancy and prenatal care, and increases risk of low birth-weight. Thus, violence in pregnancy imposes a challenge to effective prenatal care delivery with potential benefits to the mother and her baby.

Nutrition, mental health and violence: from pregnancy to postpartum Cohort of women attending primary care units in Southern Brazil--ECCAGE study.

BACKGROUND: Woman's nutritional status, before and during pregnancy, is a strong determinant of health outcomes in the mother and newborn. Gestational weight gain and postpartum weight retention increases risk of overweight or obesity in the future and they depend on the pregestational nutritional status and on food consumption and eating behavior during pregnancy. Eating behavior during pregnancy may be the cause or consequence of mood changes during pregnancy, especially depression, which increases likelihood of postpartum depression. In Brazil, a study carried out in the immediate postpartum period found that one in three women experienced some type of violence during pregnancy. Violence and depression are strongly associated and both exposures during pregnancy are associated with increased maternal stress and subsequent harm to the infant. The main objectives of this study are: to identify food intake and eating behaviors patterns; to estimate the prevalence of common mental disorders and the experience of violence during and after pregnancy; and to estimate the association between these exposures and infant's health and development. METHODS/DESIGN: This is a cohort study of 780 pregnant women receiving care in 18 primary care units in two cities in Southern Brazil. Pregnant women were first evaluated between the 16th and 36th week of pregnancy at a prenatal visit. Follow-up included immediate postpartum assessment and around the fifth month postpartum. Information was obtained on sociodemographic characteristics, living circumstances, food intake, eating behaviors, mental health and exposure to violence, and on infant's development and anthropometrics measurements. DISCUSSION: This project will bring relevant information for a better understanding of the relationship between exposures during pregnancy and how they might affect child development, which can be useful for a better planning of health actions aiming to enhance available resources in primary health care.

Socioeconomic, demographic and nutritional factors associated with maternal weight gain in general practices in Southern Brazil.

In order to describe adequacy of weight gain during pregnancy and its association with pre-pregnancy nutritional status and other factors, a cohort study of pregnant women enrolled at 16-36 weeks of gestation and followed up until delivery was carried out in prenatal care in primary care services in Rio Grande do Sul State, Brazil. Maternal weight was recorded at each prenatal care visit. Weight gain was classified as "adequate," "insufficient" or "excessive" (Institute of Medicine). Poisson regression was used to measure the associations. The sample was comprised of 667 women, and insufficient and excessive weight gain incidences were 25.8% and 44.8%, respectively. Overweight and obese before pregnancy had a significant increased risk of excessive weight gain in pregnancy (RR: 1.75; 95%CI: 1.48-2.07, RR: 1.55; 95%CI: 1.23-1.96, respectively). Women with fewer than six prenatal visits had a 52% increased risk for weight gain below recommended values. Although insufficient weight gain may still be a public health problem, excessive gain is becoming a concern that needs immediate attention in prenatal care.

Socioeconomic, demographic and nutritional factors associated with maternal weight gain in general practices in Southern Brazil / Fatores socioeconômicos, demográficos e nutricionais associados com ganho de peso gestacional em unidades básicas de saúde no Sul do Brasil

In order to describe adequacy of weight gain during pregnancy and its association with pre-pregnancy nutritional status and other factors, a cohort study of pregnant women enrolled at 16-36 weeks of gestation and followed up until delivery was carried out in prenatal care in primary care services in Rio Grande do Sul State, Brazil. Maternal weight was recorded at each prenatal care visit. Weight gain was classified as "adequate," "insufficient" or "excessive" (Institute of Medicine). Poisson regression was used to measure the associations. The sample was comprised of 667 women, and insufficient and excessive weight gain incidences were 25.8 percent and 44.8 percent, respectively. Overweight and obese before pregnancy had a significant increased risk of excessive weight gain in pregnancy (RR: 1.75; 95 percentCI: 1.48-2.07, RR: 1.55; 95 percentCI: 1.23-1.96, respectively). Women with fewer than six prenatal visits had a 52 percent increased risk for weight gain below recommended values. Although insufficient weight gain may still be a public health problem, excessive gain is becoming a concern that needs immediate attention in prenatal care.

Para caracterizar o ganho ponderal gestacional e sua associação com estado nutricional pré-gestacional e fatores relacionados à gravidez, realizou-se estudo de coorte com gestantes arroladas consecutivamente entre a 16ª e a 36ª semanas, e seguidas até o parto em serviços da rede básica de saúde do Estado do Rio Grande do Sul, Brasil. Informações do peso da gestante em cada consulta de pré-natal foram obtidas. Ganho de peso foi classificado conforme o Instituto de Medicina dos Estados Unidos. Regressão de Poisson com variância robusta foi utilizada. Incidências de ganho de peso insuficiente e excessivo das 667 gestantes foram de 25,8 por cento e 44,8 por cento, respectivamente. Gestantes com sobrepeso e obesidade pré-gestacional apresentaram risco para ganho ponderal excessivo (RR: 1,75; IC95 por cento: 1,48-2,07 e RR: 1,55; IC95 por cento: 1,23-1,96). Gestantes com menos de seis consultas de pré-natal tiveram risco de 52 por cento de ganhar peso insuficiente. Embora o ganho ponderal insuficiente persista como um problema de saúde pública, o ganho excessivo está se configurando como uma questão que precisa de atenção imediata nos serviços de pré-natal.

Violence and depressive symptoms during pregnancy: a primary care study in Brazil.

AIM: To estimate the prevalence of violence, depressive symptoms, and associated factors during pregnancy in women attending antenatal care in Brazil. METHODS: Violence was assessed using a modified version of the abuse assessment screen (ASS), and depressive symptoms were evaluated using the primary care evaluation of mental disorders (PRIME-MD). Participants were pregnant women attending 18 primary care units in Rio Grande do Sul, Brazil, between June 2006 and April 2007. A total of 712 pregnant women participated, but only 627 of them responded the ASS. RESULTS: Experience of any lifetime violence was reported by 273 (43.4%) women and 114 (18.2%) reported violence during the current pregnancy. One-third of them (n = 211) reported lifetime domestic violence and 100 (15.9%) women reported this type of violence during the current pregnancy. Experience of domestic violence during pregnancy was more common in unemployed women, among those with two or more children, with a higher consumption of alcohol, and who had not planned their current pregnancy. Of the total of sample (n = 712), 198 (27.8%) women reported six or more depressive symptoms. The presence of depressive symptoms during pregnancy was associated with low educational levels, living in a household with five or more people, and with higher consumption of alcohol during pregnancy. CONCLUSION: Pregnant women attending primary care are exposed to high rates of domestic violence, and many have clinically relevant depressive symptoms. Appropriate interventions to avoid or minimize the effects of violence and mental disorders to the well-being of the mothers and their babies are urgently required. Primary care services play an important role in identifying and supporting women at risk.

Inappropriate eating behaviors during pregnancy: prevalence and associated factors among pregnant women attending primary care in southern Brazil.

OBJECTIVE: To examine the prevalence of inappropriate eating behaviors and associated factors among pregnant women in primary care. METHOD: The Eating Disorder Examination Questionnaire was used to assess eating disorders and the Primary Care Evaluation of Mental Disorders was used to examine anxiety and depressive symptoms. Body mass index (BMI) and pregestational weight were also assessed. RESULTS: Prevalence of binge eating during pregnancy was 17.3% [95% confidence interval (CI) 14.5-20.0], followed by excessive shape (5.6%; 95% CI 4-8) and weight concerns (5.5%; 95% CI 4-8). Binge eating during pregnancy was significantly associated with binge eating before pregnancy [prevalence ratio (PR) = 3.1; 95% CI 2.2-4.3], current anxiety symptoms (PR = 1.8; 95% CI 1.3-2.4), and prepregnancy BMI < 19.8 kg/m(2) (PR = 1.6; 95% CI 1.1-2.5). The prevalence of eating disorders was 0.6% (95% CI 0.01-1.11). DISCUSSION: Eating disorder symptoms should be routinely assessed and treated during prenatal care, along with other comorbid psychiatric symptoms such as anxiety.

Dietary fibre intake of pregnant women attending general practices in southern Brazil--the ECCAGE Study.

BACKGROUND: Increase in fibre intake during pregnancy may reduce weight gain, glucose intolerance, dyslipidaemia, pre-eclampsia and constipation. Few studies have evaluated adequacy of fibre intake during pregnancy. OBJECTIVE: To assess, through an FFQ, the dietary fibre intake of pregnant women receiving prenatal care from general public practices and compare it with current guidelines. DESIGN AND SETTING: Cross-sectional analyses of a pregnancy cohort study (ECCAGE-Study of Food Intake and Eating Behaviour in Pregnancy) conducted in eighteen general practices in southern Brazil, from June 2006 to April 2007. SUBJECTS: Five hundred and seventy-eight pregnant women with mean (SD) age of 24.9 (6.5) years and mean gestational age of 24.5 (5.8) weeks. RESULTS: The mean energy intake was 11 615 kJ/d (2776 kcal/d). The mean total fibre intake (30.2 g/d) was slightly above the recommended value of 28 g/d (P < 0.001), yet 50% (95% CI 46, 54) of the women failed to meet the recommendation. Whole-grain fibre constituted only 1% of total fibre intake in the cereal group. In adjusted Poisson regression analyses, not meeting the recommendation for fibre intake was associated with alcohol intake (prevalence ratio 1.29; 95% CI 1.11, 1.50) and absence of nutritional guidance (prevalence ratio 1.22; 95% CI 1.05, 1.42) during pregnancy. CONCLUSIONS: About half of the pregnant women failed to meet the recommended fibre intake, especially those not reporting nutritional guidance during pregnancy. For most women, whole-grain cereal intake was absent or trivial. Taken together, our data indicate the need, at least in this setting, for greater nutritional education in prenatal care.

Validação relativa de Questionário de Freqüência Alimentar em gestantes usuárias de serviços do Sistema Único de Saúde em dois municípios no Rio Grande do Sul, Brasil / Validation of a Food Frequency Questionnaire conducted among pregnant women attended by the Brazilian National Health Service, in two municipalities of the State of Rio Grande do Sul, Brazil

OBJETIVOS: avaliar o desempenho do Questionário de Frequência Alimentar (QFA), desenvolvido por Sichieri e Everhart, em medir o consumo alimentar de gestantes atendidas pelo Sistema Único de Saúde (SUS), comparando as estimativas de consumo de energia e nutrientes com as obtidas por recordatórios alimentares. MÉTODOS: foram realizadas duas entrevistas com gestantes em atendimento pré-natal em Bento Gonçalves e Porto Alegre, no Rio Grande do Sul, Brasil. Na primeira, foi aplicado o QFA e, depois, os recordatórios alimentares relativos aos dois dias prévios. Na segunda, foram obtidos novos recordatórios. Médias e limites de concordância para as diferenças entre as duas avaliações de ingestão alimentar foram calculadas conforme Bland-Altman. RESULTADOS: a diferença entre os métodos mostrou que o QFA superestimou o consumo de energia e nutrientes. O coeficiente de correlação ajustado para energia variou de 0,01 (gordura insaturada) a 0,47 (cálcio). Correlações maiores foram observadas para fibras, vitamina C, ácido fólico, cálcio e potássio. Em média, 30% das gestantes foram classificadas no mesmo quartil de consumo. CONCLUSÕES: o QFA pode ser uma ferramenta útil para avaliar consumo de gestantes em estudos epidemiológicos, contanto que sejam realizados esforços para melhorar seu desempenho. É necessário avaliar a influência de características sócio-demográficas e estado de saúde na validade do método.

OBJECTIVES: to evaluate a Food Frequency Questionnaire (FFQ) previously designed by Sichieri and Everhart to provide information about food consumption among pregnant women attended by the Brazilian National Health Service. To compare the mean daily intakes of energy and nutrients as assessed using a FFQ and dietary recalls. METHODS: the study took place in two cities: Bento Gonçalves and Porto Alegre, State of Rio Grande do Sul, Brazil. During a first interview, the FFQ was administered to pregnant women, followed by two dietary recalls. In a second interview two further food recalls were obtained. The Bland-Altman analysis was used to assess the degree of agreement between the FFQ and dietary recalls. RESULTS: the FFQ produced higher energy and nutrient intakes. The correlation coefficient between nutrient intake measured using dietary recalls and using the questionnaire, after adjusting for energy intake, ranged from 0.1 (unsaturated fat) to 0.47 (calcium). The nutrients: fiber, Vitamin C, folate, calcium and potassium showed higher coefficients (above 0.4). Thirty percent of individuals were classified by the two dietary assessment methods into the same quartile. CONCLUSION: this FFQ is a useful tool for epidemiological studies among pregnant women; although efforts need to be made to improve its performance. More studies are necessary to identify sociocultural and behavioural factors that influence its validity.