Concordância da adequação do ganho ponderal gestacional segundo duas recomendações de ganho de peso

Abstract

Introduction: Recommendations for gestational weight gain, such as those from the Institute of Medicine (IOM) (2013) and based on the curves of Kac et al. (2021), have been proposed. Objective: To evaluate the agreement of maternal weight gain for gestational age according to two recommendations for gestational weight gain. Methods: This paper is based on a cross sectional study conducted between 2013 and 2014, approved by the Ethics Committee (18807113.3.0000.5013) involving pregnant women attended at Primary Healthcare Units (PHU) in Maceió. Inclusion criteria were residing in Maceió, to be assisted in the public healthcare system of Maceió, and having a singleton pregnancy. Exclusion criteria included having a multiple pregnancy, neurological disorders, and physical conditions that would compromise the ability to perform anthropometric measurements. For this study, pregnant women with less than 10 weeks of gestation or lacking pre-pregnancy weight data were excluded. A standardized questionnaire containing socioeconomic, prenatal, clinical and anthropometric informations was initially applied The current weight and height were measured, while the pre-gestational weight was self-reported by the pregnant woman or obtained from the prenatal card for to calculate the pre-pregnancy Body Mass Index (BMI). These data were used to evaluate the weight gain of pregnant women according to IOM (2013) and ranges based on the curves of Kac et al. (2021). The analyses were performed using statistical program Statistical Package for Social Science (SPSS) version 20.0, it was used Pearson's chi-square test and Fisher's exact test to evaluate the comparison between classifications and weighted Kappa values were adopted to measure the agreement between the recommendations, considering p<0.05 as significant. Results: A total of 259 pregnant women were considered, with the percentage of women with insufficient, adequate, and excessive weight gain according to IOM (2013) and recommendations based on the curves of Kac et al. (2021) being 20,1% vs. 9,7% (p<0.001), 12,7% vs. 13,1% (p=0.405), and 67,2% vs. 77,2% (p<0.001), respectively. A substantial level of agreement was found between the methods in the comparative analysis (K=0,657, p<0,001). Conclusion: The agreement between the GPG recommendations from IOM (2013) and those based on the Kac et al. (2021) curves was substantial, indicating that the differences between the classifications are not so dicrepant. However, IOM tended to classify more cases of insufficient weight gain, while the ranges based on Kac et al. (2021) tended to classify more cases of excessive weight gain when compared to each other.