WEIGHT GAIN OF PREGNANT WOMEN IN PRENATAL CARE AT PUBLIC HEALTH SERVICES, ACCORDING TO INTERGROWTH-21ST STANDARD

The total weight gain in pregnancy is multifactorial determined. Behavioral, physiological, psychological, and social changes prepare the maternal organism to generate an individual in an average period of 40 weeks. These adaptations help in the proper development of the fetus, and its subsequent healthy growth. (IOM; NRC, 2009) Around the world, different weight gain recommendations are adopted(Goldstein. RF, Abell. SK, Misso. ML, Ranasinha. S, Boyle. J, Black. MH, Li. N, Hu. G, Corrado. F, Rode. L, Kim. YJ, Jaugen. M, Song. WO, Kim. MH, Bogaerts. A, Devlieger. R, Chung. J, Teede, 2017; MacDonald et al., 2017; Viswanathan et al., 2008; Zheng et al., 2019). In 2009, the Institute of Medicine IOM)(IOM; NRC, 2009) revised the gestational weight gain recommendations considering concerns about the epidemic of overweight among women and the impacts of excessive weight gain on unfavorable outcomes throughout life (IOM; NRC, 2009). The recommendations for weight gain of the IOM(IOM; NRC, 2009) consider the classification of pre-gestational body mass index (BMI), when proposing different weight gain ranges for pregnant women with underweight, eutrophy, overweight or obesity.(Bodnar et al., 2015) Although widely used in different countries, the IOM recommendations have important limitations because the data they generated come exclusively from the North American population, which could not represent well the weight gain trajectories worldwide. (Zheng et al., 2019) Considering the limitations of the previous proposals, a prospective multicenter and multiethnic longitudinal cohort study was conducted with women without comorbidities and eutrophic, according to BMI, in the Intergrowth-21st project.(Ismail et al., 2016) The goal of the Intergrowth-21st(Ismail et al., 2016) was to monitor the evolution of the weight of pregnant women, to describe patterns of gestational weight gain, and to be used as a prescriptive curve. The results indicated a total average gain in the 40 weeks of 13.7kg, with no differences among the studied populations. (Garcia et al., 2015; Goldstein et al., 2017; Hickey, 2000; Jin et al., 2019; Marano et al., 2012) Given the methodological rigor, the Intergrowth-21st standard can be used in services that follow-up prenatal care for monitoring the weight gain of eutrophic women(Villar et al., 2013) However, studies using the prescriptive curves of the Intergrowth-21st(Ismail et al., 2016) to assess the adequacy of weight gain in pregnant women are scarce (Hickey, 2000), while most published articles compare the study patterns for fetal growth. (Goldstein et al., 2017; Marano et al., 2012; Marques et al., 2019) Thus, the objective was to evaluate the adequacy of weight gain in pregnant women under prenatal care in the Unified Health System, using the Intergrowth-21st(Ismail et al., 2016) classification, and to identify its association with sociodemographic and obstetric characteristics, health-related behaviors, in addition to comparing it with the Institute of Medicine (IOM) classification.