Revista Brasileira de Ginecologia e Obstetrícia (Mar 2012)
Influência do estado nutricional materno, ganho de peso e consumo energético sobre o crescimento fetal, em gestações de alto risco Influence of maternal nutritional status, weight gain and energy intake on fetal growth in high-risk pregnancies
Abstract
OBJETIVO: Analisar a influência do estado nutricional materno, ganho de peso e consumo energético sobre o crescimento fetal em gestações de alto risco. MÉTODOS: Estudo prospectivo de agosto de 2009 a agosto de 2010, com os seguintes critérios de inclusão: puérperas até o 5º dia; gestação de alto risco (caracterizada por complicações médicas ou obstétricas durante a gravidez); feto único e vivo no início do trabalho de parto; parto na instituição; peso materno aferido no dia do parto, e presença de intercorrência clínica e/ou obstétrica caracterizando a gravidez como de alto risco. O estado nutricional foi avaliado pelo índice de massa corporal pré-gestacional e no final da gestação, sendo as pacientes classificadas em: baixo peso, adequado, sobrepeso e obesidade. Para avaliação do consumo energético foi aplicado o Questionário de Frequência de Consumo Alimentar. Foram investigados o ganho de peso materno, dados do parto e resultados perinatais, investigando-se o crescimento fetal pela ocorrência de neonatos pequenos para a idade gestacional e grandes para a idade gestacional. RESULTADOS: Foram incluídas 374 gestantes que constituíram 3 grupos de estudo, de acordo com a adequação do peso do recém-nascido: idade gestacional adequada (270 casos, 72,2%), pequenos para a idade gestacional (91 casos, 24,3%) e grandes para a idade gestacional (13 casos, 3,5%). Na análise univariada, as mulheres com neonatos pequenos para a idade gestacional apresentaram média significativamente menor do índice de massa corporal pré-gestacional (23,5 kg/m², pPURPOSE: To analyze the influence of maternal nutritional status, weight gain and energy consumption on fetal growth in high-risk pregnancies. METHODS: A prospective study from August 2009 to August 2010 with the following inclusion criteria: puerperae up to the 5th postpartum day; high-risk singleton pregnancies (characterized by medical or obstetrical complications during pregnancy); live fetus at labor onset; delivery at the institution; maternal weight measured on the day of delivery, and presence of medical and/or obstetrical complications characterizing pregnancy as high-risk. Nutritional status was assessed by pregestational body mass index and body mass index in late pregnancy, and the patients were classified as: underweight, adequate, overweight and obese. A food frequency questionnaire was applied to evaluate energy consumption. We investigated maternal weight gain, delivery data and perinatal outcomes, as well as fetal growth based on the occurrence of small for gestational age and large for gestational age neonates. RESULTS: We included 374 women who were divided into three study groups according to newborn birth weight: adequate for gestational age (270 cases, 72.2%), small for gestational age (91 cases, 24.3%), and large for gestational age (13 cases, 3.5%). Univaried analysis showed that women with small for gestational age neonates had a significantly lower mean pregestational body mass index (23.5 kg/m², p<0.001), mean index during late pregnancy (27.7 kg/m², p<0.001), and a higher proportion of maternal underweight at the end of pregnancy (25.3%, p<0.001). Women with large for gestational age neonates had a significantly higher mean pregestational body mass index (29.1 kg/m², p<0.001), mean index during late pregnancy (34.3 kg/m², p<0.001), and a higher proportion of overweight (30.8%, p=0.02) and obesity (38.5%, p=0.02) according to pregestational body mass index, and obesity at the end of pregnancy (53.8%, p<0.001). Multivariate analysis revealed the index value during late pregnancy (OR=0.9; CI95% 0.8-0.9, p<0.001) and the presence of hypertension (OR=2.6; 95%CI 1.5-4.5, p<0.001) as independent factors for small for gestational age. Independent predictors of large for gestational age infant were the presence of diabetes mellitus (OR=20.2; 95%CI 5.3-76.8, p<0.001) and obesity according to body mass index during late pregnancy (OR=3.6; 95%CI 1.1-11.7, p=0.04). CONCLUSION: The maternal nutritional status at the end of pregnancy in high-risk pregnancies is independently associated with fetal growth, the body mass index during late pregnancy is a protective factor against small for gestational age neonates, and maternal obesity is a risk factor for large for gestational age neonates.
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