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Biete A, Gonçalves VSS, Crispim SP, Franceschini SCC, Carmo AS, Pizato N. Ultra-Processed Foods and Schooling Are Independently Associated with Lower Iron and Folate Consumption by Pregnant Women Followed in Primary Health Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6063. [PMID: 37372650 DOI: 10.3390/ijerph20126063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 06/29/2023]
Abstract
Combined deficiencies of nutrients such as iron and folic acid intake during pregnancy are related to nutritional deficiencies risk, such as anemia. The objective of this study was to analyze the association between risk factors (sociodemographic, dietary and lifestyle) and the intake of iron and folate by pregnant women followed up in Primary Health Care (PHC) in the Federal District, Brazil. A cross-sectional observational study was carried out with adult pregnant women of different gestational ages. A semi-structured questionnaire was applied by researchers trained to collect sociodemographic, economic, environmental, and health data. Two nonconsecutive 24-hour recalls (24hr) were carried out to collect data about food consumption. Multivariate linear regression models were used to analyze the association between sociodemographic and dietary risk factors and the consumption of iron and folate. The mean daily energy intake was 1726 kcal (95% CI 1641-1811), with 22.4% (95% CI 20.09-24.66) derived from ultra-processed foods (UPFs). The mean iron and folate intake were 5.28 mg (95% CI 5.09-5.48) and 193.42 µg (95% CI 182.22-204.61), respectively. According to the multivariate model, the highest quintile of ultra-processed foods intake was associated with lower iron (β = -1.15; IC 95%: -1.74; 0.55; p < 0.001) and folate intake (β = -63.23; IC 95%: -98.32; -28.15; p < 0.001). Pregnant women with high school degree presented higher iron intake (β = 0.74; IC 95%: 0.20; 1.28; p = 0.007) and folate intake (β = 38.95; IC 95%: 6.96; 70.95; p = 0.017) compared to pregnant women with elementary school degree. Folate consumption was also associated with the second gestational period (β = 39.44; IC 95%: 5.58; 73.30; p = 0.023) and pregnancy planning (β = 26.88; IC 95%: 3.58; 50.18; p = 0.024). Further research is warranted to enhance evidence on the relationship between the role of processed foods and micronutrients intake to strengthen the nutritional quality of diet of pregnant women attended in Primary Health Care.
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Affiliation(s)
- Amanda Biete
- Graduate Program in Human Nutrition, Department of Nutrition, University of Brasilia, Brasilia 70910-900, Brazil
| | - Vivian S S Gonçalves
- Graduate Program in Public Health, Department of Nutrition, University of Brasilia, Brasilia 70910-900, Brazil
| | - Sandra P Crispim
- Department of Nutrition, Federal University of Paraná, Curitiba 80210-170, Brazil
| | - Sylvia C C Franceschini
- Graduate Program in Nutrition Sciences, Department of Nutrition and Health, Federal University of Viçosa, Viçosa 36570-900, Brazil
| | | | - Nathalia Pizato
- Graduate Program in Human Nutrition, Department of Nutrition, University of Brasilia, Brasilia 70910-900, Brazil
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Miele MJ, Souza RT, Vieira MC, Pacagnella RC, Cecatti JG. A conceptual framework for nutritional evaluation, screening, and monitoring of pregnant women: Evidence from a Brazilian cohort of nulliparous women. Int J Gynaecol Obstet 2023; 161:40-50. [PMID: 36125296 DOI: 10.1002/ijgo.14469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/16/2022] [Accepted: 08/30/2022] [Indexed: 11/07/2022]
Abstract
The present review comes from five previous studies of a multicenter cohort of nulliparous pregnant women from different regions of Brazil. The first study showed a wide difference in consumption of industrialized foods among women from the south and southeast regions compared with northeastern women who chose to eat a healthier diet with fresh natural food. The second investigation intended to understand maternal eating habits, where five dietary patterns were identified: two considered healthy and three with excess protein, ultra-processed foods, fats, and sweets. Considering some barriers to classifying nutrition status during prenatal care, when data on pre-pregnancy weight is unknown, the third study developed a tool to identify three levels of risk for each gestational age range, assessed by measuring arm circumference. Applying those new tools, the associations between maternal nutrition and pregnancy outcomes were investigated: prematurity, pre-eclampsia, gestational diabetes mellitus, and small-for-gestational-age infants. From these analyses, a predictive model was developed indicating that obesity, non-white color, and dietary pattern with excess protein consumption were associated with a greater probability of adverse pregnancy outcomes. Moreover, the potential of the intergenerational influence of head circumference as a proxy for maternal nutrition was analyzed. Using a Path Analysis method, the model was evidenced by different socioeconomic variables. Finally, understanding the complexity of the nutritional assessment, the present conceptual framework was proposed for nutritional assessment, and tracking and monitoring of pregnant women.
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Affiliation(s)
- Maria J Miele
- Department of Obstetrics and Gynaecology, School of Medicine, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Renato T Souza
- Division of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, Kings College London, London, UK
| | - Matias C Vieira
- Department of Obstetrics and Gynaecology, School of Medicine, University of Campinas (UNICAMP), Campinas, SP, Brazil
- Division of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, Kings College London, London, UK
| | - Rodolfo C Pacagnella
- Department of Obstetrics and Gynaecology, School of Medicine, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - José G Cecatti
- Department of Obstetrics and Gynaecology, School of Medicine, University of Campinas (UNICAMP), Campinas, SP, Brazil
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Miele MJ, Souza RT, Calderon IM, Feitosa FE, Leite DF, Rocha Filho EA, Vettorazzi J, Mayrink J, Fernandes KG, Vieira MC, Pacagnella RC, Cecatti JG. Maternal Nutrition Status Associated with Pregnancy-Related Adverse Outcomes. Nutrients 2021; 13:2398. [PMID: 34371906 PMCID: PMC8308922 DOI: 10.3390/nu13072398] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/29/2021] [Accepted: 07/09/2021] [Indexed: 11/26/2022] Open
Abstract
Although maternal nutrition has an impact on fetal development and gestational outcome, tracking maternal nutrition in outpatient practice is still complex and involves proper technical capacitation in this area. Nevertheless, the association between nutritional variables may broaden the ability to predict the occurrence of gestational disorders and prevention management. We aimed to identify factors that could indicate the probability of adverse outcomes in mid-pregnancy. From a cohort of 1165 nulliparous pregnant women without any previous disease, the nutritional status was assessed by body mass index (BMI) and mid-upper arm circumference (MUAC), associated with dietary patterns and sociodemographic characteristics. Two predictive models with nutritional status for screening the occurrence of adverse outcomes of preterm birth, gestational diabetes mellitus, small-for-gestational-age newborns and preeclampsia were developed. The odds of adverse outcomes were higher in non-white (p < 0.05) obese women and with high protein consumption. There was no significant difference between the models, with an overall accuracy of 63% for both models and a probability of success in predicting adverse outcomes (BMI = 61%, MUAC = 52%). This study of Brazilian pregnant nulliparous women offers two possible options for early tracking of adverse gestational outcomes that should be further externally validated.
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Affiliation(s)
- Maria J Miele
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), Campinas 13083-881, SP, Brazil; (M.J.M.); (R.T.S.); (D.F.L.); (J.M.); (K.G.F.); (M.C.V.); (R.C.P.)
| | - Renato T Souza
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), Campinas 13083-881, SP, Brazil; (M.J.M.); (R.T.S.); (D.F.L.); (J.M.); (K.G.F.); (M.C.V.); (R.C.P.)
| | - Iracema M Calderon
- Department of Gynecology and Obstetrics, Botucatu Medical School, Sao Paulo State University (Unesp), Botucatu 18618-970, SP, Brazil;
| | - Francisco E Feitosa
- MEAC–Maternity School of the Federal University of Ceará, Fortaleza 60430-270, CE, Brazil;
| | - Debora F Leite
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), Campinas 13083-881, SP, Brazil; (M.J.M.); (R.T.S.); (D.F.L.); (J.M.); (K.G.F.); (M.C.V.); (R.C.P.)
- Department of Maternal and Child Health, Federal University of Pernambuco, Recife 50670-901, PE, Brazil;
| | - Edilberto A Rocha Filho
- Department of Maternal and Child Health, Federal University of Pernambuco, Recife 50670-901, PE, Brazil;
| | - Janete Vettorazzi
- Department of Obstetrics and Gynecology, Maternity Hospital, Federal University of RS, Porto Alegre 90035-903, RS, Brazil;
| | - Jussara Mayrink
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), Campinas 13083-881, SP, Brazil; (M.J.M.); (R.T.S.); (D.F.L.); (J.M.); (K.G.F.); (M.C.V.); (R.C.P.)
| | - Karayna G Fernandes
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), Campinas 13083-881, SP, Brazil; (M.J.M.); (R.T.S.); (D.F.L.); (J.M.); (K.G.F.); (M.C.V.); (R.C.P.)
- Department of Gynecology and Obstetrics, Jundiai School of Medicine, Jundiaí 13202-550, SP, Brazil
| | - Matias C Vieira
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), Campinas 13083-881, SP, Brazil; (M.J.M.); (R.T.S.); (D.F.L.); (J.M.); (K.G.F.); (M.C.V.); (R.C.P.)
- Division of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, London SE1 7EH, UK
| | - Rodolfo C Pacagnella
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), Campinas 13083-881, SP, Brazil; (M.J.M.); (R.T.S.); (D.F.L.); (J.M.); (K.G.F.); (M.C.V.); (R.C.P.)
| | - José G. Cecatti
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), Campinas 13083-881, SP, Brazil; (M.J.M.); (R.T.S.); (D.F.L.); (J.M.); (K.G.F.); (M.C.V.); (R.C.P.)
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