Revista Brasileira de Ginecologia e Obstetrícia (Jan 2011)
Impacto de um programa de orientação dietética sobre a velocidade de ganho de peso de gestantes atendidas em unidades de saúde Impact of a dietary counseling program on the gain weight speed of pregnant women attended in a primary care service
Abstract
OBJETIVO: avaliar o impacto das orientações alimentares sobre o controle de ganho de peso entre gestantes atendidas em um serviço público de saúde. MÉTODOS: o estudo foi desenvolvido em uma unidade de saúde de referência localizada na região metropolitana da cidade de Porto Alegre, no Rio Grande do Sul, Brasil. Trezentos e quinze gestantes entre a 10ª e 29ª semana gestacional foram randomizadas entre Grupo Controle e Intervenção. O Grupo Intervenção recebeu orientações alimentares de acordo com o estado nutricional, e as gestantes do Grupo Controle permaneceram no atendimento de rotina. Foram realizadas medidas de peso e altura, e calculou-se o índice de massa corporal (IMC). O estado nutricional pré-gestacional foi determinado de acordo com os seguintes critérios de IMC: baixo peso (30 kg/m²). O estado nutricional durante a gestação foi obtido de acordo a com a curva de IMC para idade gestacional adotada pelo Ministério da Saúde no Brasil. Para análise dos dados, utilizou-se o risco relativo e respectivo intervalo de confiança de 95% e os testes t de Student e χ2. Considerou-se significância estatística o valor de pPURPOSE: to evaluate the impact of dietary counseling on controlling weight gain in pregnant women, who were served in a public health service facility. METHODS: the study was conducted at a known health unit located in the metropolitan region of the city of Porto Alegre, in Rio Grande do Sul, Brazil. Three hundred and fifteen pregnant women between the 10th and 29th week of gestation were randomized to Control and Intervention Groups. The Intervention Group received dietary counseling according to nutritional status, and pregnant women in the Control Group were instructed to follow the routine of the health service facility. Weight and height were measured, and the body mass index (BMI) was calculated. The pre-gestational nutritional status was determined according to the following BMI criteria: low weight (30 kg/m²). The nutritional status during pregnancy was determined according to the BMI curve for gestational age adopted by the Health Ministry of Brazil. Data were analyzed by the relative risk and respective 95% confidence interval, and by the Student's t-test and χ2 test. Statistical significance was set at p<0.05. RESULTS: the assessment of nutritional status before pregnancy showed that 28.0% of the women were overweight and 4.1% were underweight. In the first and last interview during pregnancy, the rates of prevalence of excessive weight were 36.2 and 46.0%, respectively. The intervention proved to be effective in reducing the rate of weekly weight gain of pregnant women with excess weight (342.2 versus 420.2; p=0.015) and the prevalence of clinical complications (9.2 versus 24.85; p<0.001). CONCLUSIONS: dietary counseling was effective in decreasing the weight gain of pregnant women who were overweight and reducing clinical complications, such as gestational diabetes, preeclampsia, infant low weight, and prematurity in the Intervention Group.
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