RESUMO
Nutrition during pregnancy is one of the key elements to good maternal and child health, as well as to lifetime landmarks. However, many pregnant women go undernourished in less developed settings. The purpose of this study was to estimate the prevalence and factors associated with gestational night blindness (GXN) and maternal anemia in a cross-sectional population-based study in Cruzeiro do Sul, Acre State, Western Brazilian Amazon. All women living in the municipality admitted at the only maternity-hospital in the city to delivery of a singleton infant were eligible to this study (n = 1,525). Recruitment of participants took place between July 2015 to June 2016. GXN was assessed in the postpartum period by WHO standardized interview. Maternal anemia was defined as hemoglobin at delivery < 110.0 g/L. We estimated prevalence rates and adjusted prevalence ratios (aPR), alongside 95% confidence intervals (95% CI), of the factors associated with the outcomes through multiple Poisson regression models with robust variance. Alarming prevalence of GXN (11.5%; 95% CI, 9.97-13.25) and maternal anemia (39.4%; 95% CI, 36.84-41.95) were found. Factors associated with GXN were (aPR; 95% CI): ≥ 5 residents in the household (2.06; 1.24-3.41), smoking during pregnancy (1.78; 1.15-2.78), and attending < 6 antenatal care visits (1.61; 1.08-2.40). Factors associated with maternal anemia were (aPR; 95% CI): maternal age < 19 years (1.18; 1.01-1.38), gestational malaria (1.22; 1.01-1.49), not taking micronutrient supplements during pregnancy (1.27; 1.01-1.62), and attending < 6 antenatal care visits (1.40; 1.15-1.70). High prevalence rates of GXN and maternal anemia in these postpartum women may reflect poor assistance during antenatal care, underlying the importance of rethinking current protocols related to nutrition in pregnancy.
Assuntos
Anemia/epidemiologia , Cegueira Noturna/epidemiologia , Período Pós-Parto , Complicações na Gravidez/epidemiologia , Inquéritos e Questionários , Adulto , Biomarcadores/metabolismo , Brasil/epidemiologia , Feminino , Humanos , Gravidez , Resultado da Gravidez , PrevalênciaRESUMO
OBJECTIVE: To evaluate vitamin A status and its relationship with serum zinc concentrations among pregnant women who had previously undergone Roux-en-Y gastric bypass (RYGB), correlating these measures with anthropometric maternal characteristics and perinatal outcomes. METHODS: An analytical prospective longitudinal study was conducted at a clinic in Rio de Janeiro, Brazil, between March 3, 2008, and March 30, 2012, among women with singleton pregnancies who had previously undergone RYGB. Participants received daily oral supplementation with 5000 IU retinol and 15 mg zinc. Variables assessed included vitamin A status (serum retinol and ß-carotene; gestational night blindness), serum zinc concentration, maternal anthropometry, complications during pregnancy, and perinatal outcomes. RESULTS: Overall, 30 women participated. In all trimesters, more than 60% had inadequate serum levels of retinol or ß-carotene. Night blindness was reported by 17 (57%) women in each trimester. Only 6 (20%) women had zinc inadequacy in the first and third trimesters. No significant association was observed between serum retinol or zinc and maternal anthropometry and birth weight. Vitamin A deficiency was associated with urinary tract infection (first trimester, P=0.020) and dumping syndrome (third trimester, P=0.013). CONCLUSION: Despite RYGB and nutritional deficiencies (especially of vitamin A and zinc) increasing risks during pregnancy, there was no apparent fetal compromise when considering the analysis of birth weight and length of pregnancy at birth.
Assuntos
Derivação Gástrica , Complicações na Gravidez/epidemiologia , Vitamina A/sangue , Zinco/sangue , Adulto , Antropometria , Peso ao Nascer , Brasil , Feminino , Humanos , Recém-Nascido , Estudos Longitudinais , Cegueira Noturna/epidemiologia , Cegueira Noturna/etiologia , Gravidez , Resultado da Gravidez , Trimestres da Gravidez , Estudos Prospectivos , Vitamina A/administração & dosagem , Deficiência de Vitamina A/complicações , Deficiência de Vitamina A/epidemiologia , Deficiência de Vitamina A/etiologia , Zinco/administração & dosagem , Zinco/deficiência , beta Caroteno/sangueRESUMO
OBJECTIVE: To describe the prevalence and determinants of gestational night blindness in pregnant women receiving care in a hospital in Rio de Janeiro, Brazil. DESIGN: Cross-sectional study of pregnant and postpartum women receiving care in a public hospital in Rio de Janeiro from 1999 to 2001 (group I; n 225) or from 2005 to 2008 (group II; n 381). Night blindness was identified through a standardized and validated interview (WHO, 1996). The determinants of gestational night blindness were identified through a hierarchical logistic regression model. SETTING: Public maternity hospital in Rio de Janeiro, RJ, Brazil. SUBJECTS: Adult pregnant and postpartum women (n 606), aged ≥20 years. RESULTS: The prevalence of gestational night blindness was 9·9 %. The final model revealed that not living in the South Zone of Rio de Janeiro (distal level: adjusted OR=1·846; 95 % CI 1·002, 3·401), belonging to group I (intermediate level: adjusted OR=2·183; 95 % CI 1·066, 4·471) and for the proximal level, having a history of abortion (adjusted OR=2·840; 95 % CI 1·134, 7·115) and having anaemia during the first and second trimesters of pregnancy (adjusted OR=3·776; 95 % CI 1·579, 9·029) were determinants of gestational night blindness. CONCLUSION: Gestational night blindness should be assessed for during the prenatal care of all pregnant women, especially those living in deprived areas of the city and/or who have a history of abortion or anaemia. Nutritional monitoring is recommended during pregnancy to control gestational night blindness.
Assuntos
Ácido Ascórbico/administração & dosagem , Ácido Fólico/administração & dosagem , Alimentos Fortificados , Ferro da Dieta/administração & dosagem , Cegueira Noturna/epidemiologia , Vitamina A/administração & dosagem , Aborto Induzido , Adulto , Anemia Ferropriva/complicações , Anemia Ferropriva/tratamento farmacológico , Brasil/epidemiologia , Estudos Transversais , Suplementos Nutricionais , Feminino , Humanos , Modelos Logísticos , Cegueira Noturna/etiologia , Cegueira Noturna/prevenção & controle , Período Pós-Parto , Gravidez , Cuidado Pré-Natal , Prevalência , Fatores Socioeconômicos , Deficiência de Vitamina A/complicações , Deficiência de Vitamina A/tratamento farmacológico , Adulto JovemRESUMO
INTRODUCTION: In developing countries, night blindness is a very common public health problem among pregnant women. OBJECTIVE: Evaluate the effect of the changes occurred on prenatal care concerning prenatal nutritional care on the occurrence of night blindness (XN) in adult pregnant women in public maternity hospital in Rio de Janeiro between 1999-2001 and between 2007-2008. METHODS: Two cross-sectional studies were conducted, been the first one conducted between 1999-2001 and the second one between 2007-2008. Were studied 402 puerperal women, 225 between 1999-2001 (GI) and 177 between 2007-2008 (GII). The gestational XN was investigated during the immediate puerperium (GI) and during the prenatal/puerperium (GII), diagnosed by the World Health Organization. The study collected sociodemographic, clinical, obstetric, anthropometric and prenatal care information. RESULTS: It verified significant reduce of prevalence of gestational XN (GI = 18.7% e GII = 0.6%, p < 0.001). The occurrence of gestational XN was associated to sanitary conditions, education level, more than six prenatal consultations, miscarriage at last pregnancy, higher average number of deliveries, average number of prenatal care consultations and prenatal nutritional (p < 0.05). There was no association between gestational XN and marital status, skin color, pre-gestational nutritional status, adequacy of gain of total gestational weight, gestational anaemia and average number of pregnancies (p > 0.05). CONCLUSION: The inclusion of nutritional care in routine prenatal care may have contributed to the reduction of gestational XN. Studies to assess the nutritional intervention in the prevention and treatment of gestational XN at regions at greatest risk are suggested.
Introducción: En los países en desarrollo, la ceguera nocturna (CN) es un problema muy común de la salud pública entre las mujeres embarazadas. Objetivo: Evaluar el efecto de los cambios ocurridos en la atención prenatal sobre el cuidado nutricional prenatal sobre la aparición de CN en mujeres adultas embarazadas en una maternidad pública en Rio de Janeiro entre 1999-2001 y entre 2007-2008. Métodos: Se realizaron dos estudios transversales, el primero entre 1999-2001 y el segundo entre 2007-2008. Se estudiaron 402 mujeres puérperas, 225 entre 1999-2001 (GI) y 177 entre 2007-2008 (GII). La CN gestacional fue investigada durante el puerperio inmediato (GI) y durante el prenatal/puerperio (GII), diagnosticada por la Organización Mundial de La Salud. El estudio incluió informaciones sociodemográficas, clínicas, obstétricas, antropométricas y del cuidado prenatal. Resultados: Se verificó reducción significativa de la prevalencia de CN gestacional (GI = 18,7% e GII = 0,6%, p < 0,001). La ocurrencia de CN gestacional se asoció con las condiciones sanitarias, el nivel de educación, más de seis consultas prenatales, abortos espontáneos en el último embarazo, mayor número promedio de partos, el número promedio de consultas de atención prenatal y de nutrición prenatal (p < 0,05). No hubo asociación entre CN gestacional y el estado civil, color de piel, estado nutricional pregestacional, adecuación de la ganancia de peso durante la gestación, incluyendo anemia gestacional y el número medio de embarazos (p > 0,05). Conclusión: La inclusión de la atención nutricional en el cuidado prenatal de rutina puede haber contribuido para la reducción de CN gestacional. Se sugiere más estudios para evaluar la intervención nutricional en la prevención y el tratamiento de CN gestacional en las regiones de mayor riesgo.
Assuntos
Cegueira Noturna/epidemiologia , Cegueira Noturna/prevenção & controle , Cuidado Pré-Natal/estatística & dados numéricos , Fenômenos Fisiológicos da Nutrição Pré-Natal , Adulto , Antropometria , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Período Pós-Parto , Gravidez , Prevalência , Adulto JovemRESUMO
BACKGROUND: Studies showed a rise in obesity prevalence in world population and evidences point to a possible association with vitamin A deficiency (VAD). The objective of this study is to assess vitamin A nutritional status through functional [night blindness diagnosis-xerophthalmia (XN)] and biochemical (serum levels and retinol liver store) indicators of class III obesity individuals and its association. METHODS: We studied 114 patients of both genders with BMI ≥40 kg/m2, candidates to bariatric surgery at Clínica Cirúrgica Carlos Saboya in Rio de Janeiro, Brazil. XN was diagnosed through a standardized interview (WHO and MacLaren and Frigg), and serum levels and retinol liver store were quantified by HPLC-UV with <1.05 µmol/L and < 20 mg/g cutoffs for VAD, respectively. RESULTS: XN prevalence was 23.8%, and serum levels and retinol liver store inadequacy were 14.0% and 80%, respectively. The association between VAD and XN presence (p = 0.003) was observed with the biochemical indicator and the gold standard, retinol liver store (p = 0.003 and p = 0.018, respectively). Means were 59.3% (sensitivity), 87.4% (specificity), and 80.8% (accuracy) as regards to the XN role in predicting VAD according to the biochemical indicator. As regards to retinol liver store, XN diagnosis presented 48% of sensitivity and 75% of specificity. VAD highest indexes occurred in patients with highest BMI (rs-0.21, p = 0.02). Distribution of XN prevalence was 59.2% according to serum retinol. CONCLUSIONS: VAD and XN prevalence was high in class III obesity individuals, and the functional indicator for XN diagnosis may be a promising method for diagnosis in this group.
Assuntos
Fígado/metabolismo , Cegueira Noturna/epidemiologia , Obesidade Mórbida/metabolismo , Deficiência de Vitamina A/epidemiologia , Vitamina A/metabolismo , Xeroftalmia/epidemiologia , Adulto , Brasil/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cegueira Noturna/etiologia , Cegueira Noturna/metabolismo , Estado Nutricional , Obesidade Mórbida/sangue , Obesidade Mórbida/epidemiologia , Prevalência , Vitamina A/sangue , Deficiência de Vitamina A/complicações , Deficiência de Vitamina A/metabolismo , Xeroftalmia/metabolismoRESUMO
This study verified the night blindness prevalence, the first manifestation of this deficiency, and its association with socioeconomic, nutritionals and obstetric variables of 92 pregnant who were assisted on a health municipal center in Diamantina, Vale do Jequitinhonha. Data was collected through a model interview recommended by WHO (1996) to diagnose night blindness. The statistic analysis used Fisher exact test and Wilcoxon test. The results showed a higher prevalence of night blindness at Diamantina districts and neighbor cities (13.04%). No significant association was found between night blindness and socioeconomic and obstetric variables (p>0.05). It was observed a low vitamin A levels by pregnant with night blindness (4.4). This found shows the necessity of more investigations on vitamin A deficiency in order to help prevent, diagnose and combat this issue.
Assuntos
Cegueira Noturna/epidemiologia , Cegueira Noturna/etiologia , Estado Nutricional , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/etiologia , Deficiência de Vitamina D/complicações , Adolescente , Adulto , Feminino , Humanos , Gravidez , Prevalência , Fatores Socioeconômicos , Adulto JovemRESUMO
Este estudo investigou a prevalência de cegueira noturna e sua associação com as variáveis socioeconômicas, nutricionais e obstétricas de 92 gestantes atendidas em um posto municipal de saúde da cidade de Diamantina, Alto Vale do Jequitinhonha (MG). Para a coleta de dados, utilizou-se a entrevista preconizada pela OMS (1996) para o diagnóstico da cegueira noturna. Na análise estatística, utilizou-se o teste exato de Fisher e o de teste de Wilcoxon. Os resultados demonstraram uma prevalência maior de cegueira noturna nos distritos de Diamantina (15,38 por cento) e cidades vizinhas (13,04 por cento). Não foi encontrada associação significativa entre cegueira noturna e as variáveis socioeconômicas e obstétricas (p>0,05). No entanto, observou-se um menor consumo de vitamina A pelas gestantes com cegueira noturna (4,4 por cento). Tais achados apontam a necessidade de realizar novas investigações acerca da deficiência de vitamina A, a fim de subsidiar ações de prevenção e combate a esse agravo neste grupo em particular.
This study verified the night blindness prevalence, the first manifestation of this deficiency, and its association with socioeconomic, nutritionals and obstetric variables of 92 pregnant who were assisted on a health municipal center in Diamantina, Vale do Jequitinhonha. Data was collected through a model interview recommended by WHO (1996) to diagnose night blindness. The statistic analysis used Fisher exact test and Wilcoxon test. The results showed a higher prevalence of night blindness at Diamantina districts and neighbor cities (13.04 percent). No significant association was found between night blindness and socioeconomic and obstetric variables (p>0.05). It was observed a low vitamin A levels by pregnant with night blindness (4.4). This found shows the necessity of more investigations on vitamin A deficiency in order to help prevent, diagnose and combat this issue.
Assuntos
Adolescente , Adulto , Feminino , Humanos , Gravidez , Adulto Jovem , Cegueira Noturna/epidemiologia , Cegueira Noturna/etiologia , Estado Nutricional , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/etiologia , Deficiência de Vitamina D/complicações , Prevalência , Fatores Socioeconômicos , Adulto JovemRESUMO
OBJECTIVE: Gestational night blindness (XN) is associated with increased risk of reproductive morbidity and mortality. This study investigated the prevalence of gestational XN among postpartum women treated in a public maternity hospital in the city of Rio de Janeiro, Brazil and evaluated its association with maternal and neonatal (cord blood) serum retinol concentrations. METHODS: XN was evaluated retrospectively, using an interview according to guidelines of the World Health Organization, in 222 postpartum women (< or = 6 h after delivery) after singleton births who had low obstetric risk. Serum retinol concentrations were measured according to the modified Bessey method, with a cutoff point lower than 1.05 micromol/L for inadequate serum retinol concentration. RESULTS: Prevalence of gestational XN was 18%, and inadequate maternal and cord blood serum retinol concentrations were found in 24.4% and 45.5% of samples, respectively. The results associated gestational XN with inadequate maternal serum retinol concentration (P = 0.000), and an association was observed between maternal and neonatal serum retinol concentrations (P = 0.000). A poor association was observed between maternal XN and serum levels of retinol in newborn children (P = 0.06). CONCLUSIONS: The results suggest that prevalence of gestational XN and inadequate serum retinol concentration among postpartum women and newborns is a concern, calling attention to the need for studies in other parts of Brazil. In addition, the risk of inadequate serum retinol in newborns was significantly higher among infants of postpartum women with serum retinol levels below 1.05 micromol/L. Gestational XN was associated with inadequate levels of maternal serum retinol, and the results suggest a poor relation between maternal XN and vitamin A nutritional status of newborns.
Assuntos
Cegueira Noturna/epidemiologia , Vitamina A/sangue , Adulto , Biomarcadores/sangue , Brasil/epidemiologia , Distribuição de Qui-Quadrado , Comorbidade , Feminino , Sangue Fetal , Humanos , Recém-Nascido , Entrevistas como Assunto , Cegueira Noturna/sangue , Estado Nutricional/fisiologia , Período Pós-Parto/sangue , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/epidemiologia , Estudos Retrospectivos , Deficiência de Vitamina A/epidemiologiaRESUMO
This study evaluated the prevalence of gestational nightblindness among postpartum women seen at the University Maternal Hospital of the Federal University in Rio de Janeiro, Brazil and the association of this symptom with a biochemical indicator (serum retinol levels) and sociodemographic, anthropometric and antenatal care variables. In total, 262 postpartum women, who did not receive vitamin A supplementation during pregnancy, were interviewed. Gestational nightblindness was diagnosed through the standardized interview as proposed by WHO. Serum retinol levels were evaluated by spectrophotometry. Gestational nightblindness relating to low levels of serum retinol (<1.05 micromol/L, p = 0.000) was diagnosed in 17.9% of subjects interviewed. Less than five antenatal care appointments (odds ratio [OR] = 2.179; confidence interval [CI] 95% = 1.078 - 4.402) and a history of one or more miscarriage(s) (OR = 2.306; CI 95% = 1.185 - 4.491) were predictors for gestational nightblindness. These findings justify the need for nutritional counselling, aimed at improving the vitamin A nutritional status, especially among pregnant women with a history of previous miscarriages and poor antenatal care.
Assuntos
Cegueira Noturna/epidemiologia , Complicações na Gravidez/epidemiologia , Deficiência de Vitamina A/epidemiologia , Vitamina A/administração & dosagem , Adulto , Brasil/epidemiologia , Feminino , Humanos , Cegueira Noturna/etiologia , Estado Nutricional , Período Pós-Parto , Gravidez , Complicações na Gravidez/etiologia , Cuidado Pré-Natal , Diagnóstico Pré-Natal , Prevalência , Vitamina A/sangue , Deficiência de Vitamina A/complicaçõesRESUMO
Vitamin A deficiency is considered one of the most important of the easily preventable public health problems in a number of countries, including Brazil. The objective of this study was to review the scientific literature in the MEDLINE and LILACS databases that was published between 1970 and 2000 concerning vitamin A deficiency, and to assess the occurrence of hypovitaminosis A in Latin America, especially Brazil. Our research showed that until around 1980 the public health concerns focused mainly on the importance of vitamin A in ensuring good vision. In the second half of the 1980s, epidemiological studies suggested that, on a population level, subclinical vitamin A deficiency could also have a negative effect on metabolic functions, with a great impact on childhood morbidity and mortality. Marginal vitamin A deficiency has been reported in all the regions of Brazil for which there are data available, with high prevalences in various age groups. This situation is inexcusable, given the health care technology and resources that are now available. There must be a commitment to reducing vitamin A deficiency in order to ensure the adequate development of future generations.
Assuntos
Deficiência de Vitamina A/epidemiologia , Brasil/epidemiologia , Região do Caribe , Criança , Pré-Escolar , Doenças da Córnea/epidemiologia , Bases de Dados Factuais , Humanos , Lactente , Recém-Nascido , América Latina , MEDLINE , Cegueira Noturna/epidemiologia , Prevalência , Saúde Pública/normas , Saúde Pública/estatística & dados numéricos , Transtornos da Visão/epidemiologia , Vitamina A/análiseRESUMO
Dietary and biochemical data have indicated that hypovitaminosis A is a public health problem in Northeast Brazil. However, there are few reports regarding clinical signs of hypovitaminosis A. Therefore, an epidemiological study was designed to study this problem. The study as done was primarily a review of hospital records of xerophthalmia in each state with attention paid to other nutrition factors. It was found that xerophthalmia is a problem in Northeast Brazil and a cause of blindness in certain areas. However, the number varied greatly from some states to others. Around 1,000 preschool-age children were recorded as blind from vitamin A deficiency in a 1-year period. It was also noted that the peak incidence of xerophthalmia and blindness was around 1 year of age. The government of Brazil is taking urgent measures to combat this deficiency with such measures as the supplementation of sugar with vitamin A and the distribution of massive doses of vitamin A.