Jornal de Distúrbios Nutricionais e Terapia

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Congresso de Nutrição 2015: Práticas alimentares de mulheres grávidas em relação ao estado antropométrico de bebês de 0 a 6 semanas no distrito de Vhembe, província de Limpopo - Mushaphi L F - Universidade de Venda

Mushaphi LF

Contexto: A dieta de muitos sul-africanos consiste em mingau como alimento básico, que normalmente é consumido com vegetais, legumes e uma pequena quantidade de alimentos de origem animal. O consumo inadequado de uma dieta balanceada pode resultar em baixo ganho de peso durante a gravidez, aumentando o risco de parto prematuro, baixo peso ao nascer e defeitos congênitos.

Objetivo: conhecer as práticas alimentares maternas em relação ao estado antropométrico de bebês de 0 a 6 semanas.

Cenário: O estudo foi realizado em quatro clínicas do distrito de Vhembe, província de Limpopo, África do Sul.

Métodos: Um estudo expressivo transversal foi realizado entre duzentas e quarenta (240) mulheres grávidas e seus filhos pequenos foram nomeados convenientemente de quatro clínicas no distrito de Vhembe. Medidas antropométricas foram tomadas seguindo técnicas padrão. Dados sobre práticas alimentares e informações sociodemográficas foram coletados usando um questionário, permissão e liberação foram obtidas e os direitos dos participantes foram respeitados.

Este estudo é o primeiro a fornecer dados sobre as práticas alimentares de mulheres grávidas, associação entre o peso da mãe durante a gravidez e o peso do bebê em vilas rurais da África do Sul. A descoberta revelou que a maioria dos participantes do estudo atual era muito jovem. Os adolescentes geralmente não têm conhecimento adequado sobre exatamente o que é necessário nutricionalmente durante a gravidez. Talvez isso possa ser atribuído ao fato de que os adolescentes no estágio requerem uma dieta variada para atender às maiores necessidades de nutrientes e energia da gravidez e suportar o ganho de peso adequado. As descobertas revelaram que a maioria dos participantes do estudo atual ganhou peso insuficiente durante a gravidez. Mulheres pobres tendem a ganhar menos peso durante a gravidez, têm menor ingestão de micronutrientes e isso pode ter efeitos prejudiciais no resultado da gravidez.

The findings of the study revealed that majority of the participants were unemployed. Surprisingly there is no significant difference between the employment status of the mother and Z-scores of children (WAZ (p=0.700), HAZ (p=0.553) and BAZ (p=0.728). However, women living in low socio economic status are often malnourished before pregnancy due to inadequate food intake putting them at higher risk of having low birth and preterm delivery. Nevertheless, unemployment did not affect the z-scores of the infants in the current study. These findings are congruent with previous study done in Nigeria which indicated that majority of pregnant mothers were unemployed. In addition, poor weight of the pregnant women influenced by the socio-economic status of her family has a direct effect on the birth weight of her child. About 41.7% of the participants in the current study spend R1000-R2000 on food while 36.7% of the participants spend R500-R1000 on food. Perhaps this variation on money spend on food could be attributed to the household income and employment status of the members of household. Studies have shown relationship between dietary diversity, socioeconomic status and demographic characteristics.

The findings of the study revealed that participants ate three meals per day. Regular meals are not expected to be skipped during pregnancy, nutritious foods are directly linked to higher chance of a normal birth weight, improving brain development and reducing the risk of many birth defects. “Post-partum outcomes for mother and infants are linked to maternal consumption habits during pregnancy.

In addition, one of the main meals in the current study comprised of starchy foods. Starchy foods eaten in the present study include porridge, rice, samp and bread. The findings of the current study correlate with the study done in Ethiopia. “Adequate consumption of starchy food during pregnancy is known to support rapid growth of the foetus and also assist in maintaining weight gain during pregnancy”. The participants in the current study ate meat, legumes and dairy product. “Outcome of the pregnancy depends on the mother’s health. Consumption of protein food during pregnancy is vital to support growth of the foetus and this is linked to low risk of neonatal death and birth defects”. These findings are congruent with study done in Nigeria were it was reported that participants ate meat and meat products including those from home owned animals.

The most indigenous vegetables consumed in the current study were Delele, Vowa and Phuri. Access to indigenous food has been shown to be key determinant of dietary adequacy and consumption of these foods high in iron content. “Access to indigenous food has been shown to be key determinant of dietary adequacy therefore consumption of these foods is a key consideration during pregnancy”.

The findings of the study revealed that participants had pica during pregnancy. Consumption of non- food items in large quantities is common among pregnant women in rural villages and this could cause intestinal obstructions interfering with the absorption of essential nutrients which are vital for the growth of the foetus [26]. This is due to the fact that women lack of knowledge concerning the effects of pica on the foetus. Non-food items consumption during pregnancy can lead to malnutrition and deficiencies of vitamins and minerals. These findings are congruent with previous studies which indicated that pregnant women have been practicing pica and this can cause complication during pregnancy.

During pregnancy women are restrict to eat certain food items according to culture and this could result in fewer food consumption which in turn can lead to underweight and overweight. Surprisingly our study indicates negative correlation between mother’s BMI and the infant’s WAZ (r=-0.48; p=0.515). These indicate that the mother’s weight during pregnancy is not only the contributing factor to infant’s weight during birth. Factors such as dietary practices during pregnancy should be considered when studying the relationship between the mother’s weight during pregnancy and their infants during birth. However, women who have poor weight gain during pregnancy face greater risks of delivery preterm babies and their infants set off on a weaker development path, both physically and intellectually.25 Furthermore, Girls born with low birth weight are more likely to become poorly nourished children and poorly grown women and are, therefore, likely to give birth to low birth weight infants resulting in the vicious cycle of malnutrition [14]. In addition, nutritional status of mothers is one of the most important factors of foetal growth and development.

Results: 45 percent of the study participants have eaten carrots, bananas, apples, spinach, cabbage and beetroots during pregnancy while 26.7% of the study participants reported that they need eaten carrots, oranges, bananas, apples, spinach, cabbage and beetroots during pregnancy. The majority of participants (91.7%) received folate and iron supplements while 8.3% received iron, folate and calcium supplements during pregnancy. Half of the participants at the time of pregnancy had normal BMI, 13.3% were underweight, 30% were observed overweight and 6.7% were observed obese. More than third quarter of infants (80%) at birth had normal WAZ (-1SD to ≤+2SD), 6.7% of infants were underweight (<-3SD to <-2SD) while 11.7% of infants were mildly underweight (-2SD to <-1SD). 

Conclusão: A idade materna e as práticas alimentares durante a gravidez têm um impacto significativo nos resultados do parto. O peso da mãe durante a gravidez não é o único fator que contribui para o peso do bebê durante o parto. Fatores como práticas alimentares durante a gravidez e status socioeconômico precisam ser considerados ao estudar a associação entre o peso da mãe durante a gravidez e seus bebês. A prevalência de baixo peso, emagrecimento e nanismo é devido ao baixo ganho de peso durante a gravidez e dieta materna inadequada (dieta desequilibrada). Mães que foram subnutridas durante a gravidez deram à luz bebês com baixo peso ao nascer.

Nota: Este trabalho foi parcialmente apresentado na 4ª Conferência e Exposição Internacional sobre Nutrição, realizada de 26 a 28 de outubro de 2015 em Chicago, Illinois, EUA.