Antropometria em mulheres e desfechos reprodutivos

Abstract

Maternal health determined by womens nutritional status may negatively influence uterine and early life growth and development. It is also associated with reproductive health and pregnancy viability. Extreme nutritional impairment such as undernutrition and obesity are conditions that coexist in low and middle income countries, like Brazil, a nation that is rapidly transitioning with an emergent economy. Thus, we investigated the relationships between maternal nutritional status and reproductive outcomes occurrence, using data from a Brazilian population representative survey. We conducted a cross-sectional study using DHS data from 2006 of 6,724 women and their singleton pregnancies from 2001 until data collection. Women and children anthropometry was assessed following international protocols. Maternal altered anthropometry was the main exposure of this thesis. The outcomes were the fatal events such as spontaneous abortion, stillbirth and mortality, all self-reported by the mothers, and also the altered children nutrition, detected by two nutritional indexes, height-for-age and body mass index in z scores from the World Health Organization reference population. Data analysis was performed in Stata, version 12, using the survey module, which allows to consider the complex sample design. Logistic, linear and Poisson regression models were used to estimate associations between maternal altered anthropometry and the reproductive outcomes occurrence (mean differences, PR, OR, 95%CI, Wald test, trend test and statistical significance of 5%), adjusting for confounders. Spontaneous abortion and stillbirths were more frequent among women with overweigh, global and abdominal obesity. After adjustments, each BMI unit increase (OR = 1.05; 95%CI: 1.02-1.08) and WHR (OR = 1.32; 95%CI: 1.03-1.69), the chance of having an abortion was also increased. Abdominal obesity was strongly associated to the stillbirth occurrence (OR = 2.91; 95%CI: 1.32-6.44) while global obesity was highly predictive of abortions (OR = 2.49; 95%CI: 1.45-4.26). Brazilian women abdominal obesity and excess of weight were strong predictors of neonatal death (OR = 3.24; 95%CI: 1.30-8.09; OR = 2.44; 95%CI: 1.17-5.07, respectively). On the other hand, their low stature and undernourishment were determinant factors of post-neonatal death (OR = 4.08; 95%: 1.27-13.13; OR = 8.23; 95%CI: 2.31-29.32, respectively). The results related to the children nutritional outcomes showed that, after adjustments, children whose mothers height was < 145 cm had 1.2 lower HAZ than children whose mothers were 160 cm tall (p-trend < 0.0001) and children whose mothers had BMI 35 kg/m2 had HAZ 0.4 higher when compared to the mothers of normal weight (p-trend < 0.0001). These results provide important epidemiological information in the direction of maternal altered anthropometry, especially obesity indexes, and the reproductive outcomes occurrence.