Nutritional status in high risk pregnancies: complications of delivery and postpartum, and analysis of dietary intake

Author(s)

Leticia Vieira de Paiva

• Document type: Master's Dissertation
• Press: São Paulo.
• Institution: Universidade de São Paulo (USP). Faculdade de Medicina (FM/SBD)
• Defense date: 2012-03-28

Examining board members

Roseli Mieko Yamamoto Nomura; Maria de Lourdes Brizot; Mônica Lopez Vazquez

• Advisor: Roseli Mieko Yamamoto Nomura

Abstract

OBJECTIVE: To assess the association between maternal obesity and the occurrence of delivery and postpartum complications in high risk pregnancies, and to analyze the dietary intake of these pregnant women. METHODS: Prospective and observational study conducted from August 2009 to August 2010, with the following inclusion criteria: admission to the 5th day, maternal age 18-year-old, high-risk pregnancy, single pregnancy, fetus alive at the beginning of labor, birth at the institution, maternal weight measured at birth. Nutritional status in late pregnancy was assessed by body mass index (BMI), and applying the curve Atalah. The patients were classified as: underweight, appropriate, overweight and obesity. The dietary intake was evaluated applying a food frequency questionnaire. The complications of delivery and postpartum, investigated during the hospitalization and 30 days after discharge, were: infection and / or secretion in the surgical wound, urinary tract infection, puerperal infection, fever, hospitalization, antibiotics, and composite morbidity (at least one puerperal complication). RESULTS: We included 374 postpartum women classified by the final BMI: underweight (n=54, 14.4%), appropriate (n=126, 33.7%), overweight (n=105, 28.1%) and obesity (n=89, 23.8%). There was no significant difference in the proportion of cesarean when compared the following groups: underweight and appropriate (68.3%), overweight (76.2%) and obesity (78.6%, P=0.201). Maternal obesity was significantly associated with the following puerperal complications: surgical wound infection (16.8%, P=0.042), urinary tract infection (9.0%, P= 0.004), antibiotic use (12.3%, P<0.001) and composite morbidity (25.6%, P=0.016). The logistic regression model showed that obesity in late pregnancy is an independent variable in predicting the composite morbidity (OR: 2.09, 95% CI: 1.15 to 3.80, P=0.015). The analysis of dietary intake showed average energy consumption similar in the groups: underweight and appropriate (2344 cal/day), overweight (2433 cal/day) and obesity (2450 cal/day, P=0.640). There was no significant difference in the average daily consumption of macro-and micronutrients among the groups studied. CONCLUSION: Maternal obesity at the end of high-risk pregnancy is independently associated with the occurrence of postpartum infectious complications, showing the need for more efficient monitoring of maternal weight gain in these pregnancies (AU)

• FAPESP's process: 09/11425-7 - Nutricional state and corporal composition of the maternal organism: association with the complications at delivery and post-partum in high risk pregnacies.
• Grantee: Letícia Vieira de Paiva
• Support Opportunities: Scholarships in Brazil - Master