Índice de massa corporal e ganho de peso gestacional como fatores preditores de complicações e do desfecho da gravidez Body mass index and gestational weight gain as factors predicting complications and pregnancy outcome

Abstract

OBJETIVO: Avaliar o impacto do índice de massa corporal (IMC) no início da gestação e do ganho de peso no desfecho gestacional, para que esta medida possa ser implantada e valorizada pelos serviços de saúde de pré-natal. MÉTODO: Estudo transversal de base populacional. Na pesquisa, foram incluídos todos os nascimentos ocorridos nas duas únicas maternidades do município do Rio Grande (RS), em 2007. Dentre as 2.557 puérperas entrevistadas, o cálculo do IMC só pôde ser realizado em 1.117 puérperas. A análise foi realizada no programa Stata 11. Nos desfechos hipertensão, diabetes mellitus, trabalho de parto prematuro e cesárea foi realizada regressão logística. No caso do peso ao nascer, o ajuste ocorreu pela regressão logística multinomial, tendo como categoria base o grupo de 2.500 a 4.000 g. Em todas as análises foi adotado valor pPURPOSE: To evaluate the impact of body mass index (BMI) at the beginning of pregnancy and weight gain on pregnancy outcome so that this measure can be implemented and valued by prenatal care health services. METHOD: Cross-sectional population-based study of all births in the only two hospitals in Rio Grande city (Brazil), in 2007. Among the 2,557 mothers interviewed, it was possible to calculate BMI in only 1,117. The Stata 11 software was used for data analysis. Logist regression was applied to the outomes involving diabetes mellitus, premature labor and cesarean section. Regarding birth weight, data were adjusted by multinomial logistic regression using as base category the group of 2,500 to 4,000 g. The level of significance was set at p-value <0.05 in a two-tailed test. RESULTS: There was no increased risk of hypertension or diabetes in patients in the different groups of BMI and weight gain. The risk of preterm delivery was evident in the group with a weight gain ≤8 kg (p<0.05). Regarding the route of delivery, it was observed that the higher the BMI in early pregnancy (p=0.001) and the greater the weight gain during pregnancy (p=0.004), the greater the risk of surgical delivery, which reached 11% in the group of obese mothers (p=0.004) and 12% in the group with a weight gain ≥17 kg (p=0.001). The weight of the newborns was influenced by BMI and weight gain, and the higher the BMI in early pregnancy and the gestational weight gain, the greater the risk of macrosomia. CONCLUSION: The monitoring of BMI and weight gain during pregnancy is a low cost and useful procedure for the establishment of nutritional interventions aimed at reducing maternal and fetal risks.

Keywords

• Cuidado pré-natal
• Índice de massa corporal
• Gravidez de alto risco
• Parto
• Peso ao nascer
• Prenatal care
• Body mass index
• Pregnancy, high-risk
• Parturition
• Birth weight