Estado actual del conocimiento sobre el cuidado nutricional de la mujer embarazada

Luciana Barretto, María José Mackinnon, Mabel Susana Poy, Adriana Wiedemann, Laura Beatriz López

Resumen


El embarazo implica una importante actividad anabólica que determina un aumento de las necesidades nutricionales con relación al periodo preconcepcional. El presente trabajo se propone revisar los conocimientos actuales sobre las necesidades energéticas, de macro y micronutrientes durante la gestación, así como también los lineamientos para abordar los trastornos gastrointestinales frecuentes durante el embarazo, la problemática de pica y la valoración antropométrica para asegurar una ganancia de peso óptima. La mayoría de los nutrientes requeridos por la gestación pueden ser proporcionados por una alimentación completa y balanceada. Actualmente la evidencia científica demuestra que la suplementación rutinaria con hierro y ácido fólico durante la gestación, constituye una práctica que previene la anemia ferropénica, los trastornos del tubo neural y los nacimientos pretérmino. La suplementación intermitente puede ser una alternativa igualmente eficaz. Cuando la alimentación no garantiza un aporte adecuado también pueden ser necesarios suplementos de yodo, vitamina B12 y vitamina D. La valoración antropométrica mediante el patrón de ganancia de peso debiera estar presente en cada consulta del control prenatal para evitar complicaciones maternas y fetales. En situaciones donde el peso materno no se puede valorar, la circunferencia muscular del brazo es una alternativa posible para realizar una evaluación general ya que se correlaciona de manera adecuada con el aumento de peso materno. Las mediciones de los pliegues cutáneos del bíceps, tríceps y subescapular constituyen otra alternativa que resulta de utilidad para evaluar los depósitos grasos y su localización, en forma complementaria a la ganancia de peso corporal.


Palabras clave


Embarazo; Estado Nutricional; Soporte nutricional; Fisiología de la nutrición materna; Nutrición materna; Cuidado prenatal

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Referencias


Drake AJ, Walker BR. The intergenerational effects of fetal programming: non-genomic mechanisms for the inheritance of low birth weight and cardiovascular risk. J Endocrinol. 2004; 180(1): 1-16.

National Research Council. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (Macronutrients). Washington, DC: The National Academies Press, 2005.

Kaiser L, Allen LH; American Dietetic Association. Position of the American Dietetic Association: Nutrition and Lifestyle for a Healthy Pregnancy Outcome. J Am Diet Assoc. 2008; 108(3): 553-61.

Hamdi K, Bastani P, Gafarieh R, Mozafari H, Hashemi SH, Ghotbi MH.The influence of maternal ketonuria on fetal well-being tests in postterm pregnancy. Arch Iran Med. 2006; 9(2): 144-7.

Onyeije CI, Divon MY. The impact of maternal ketonuria on fetal test results in the setting of postterm pregnancy. Am J Obstet Gynecol. 2001; 184(4): 713-8.

Craig WJ, Mangels AR; American Dietetic Association. Position of the American Dietetic Association: vegetarian diets. J Am Diet Assoc. 2009; 109(7): 1266-82.

Ministerio de Salud. Encuesta Nacional de Nutrición y Salud. Documento de Resultados 2007. Buenos Aires: Ministerio de Salud, 2007.

Ota E, Tobe-Gai R, Mori R, Farrar D. Antenatal dietary advice and supplementation to increase energy and protein intake. Cochrane Database Syst Rev. 2012; 9:CD000032.

Food and Agriculture Organization (FAO). Fats and fatty acids in human nutrition: Report of an expert consultation. FAO Food Nutr Pap. 2010; 91: 1-166.

Gould JF, Smithers LG, Makrides M. The effect of maternal omega-3 (n-3) LCPUFA supplementation during pregnancy on early childhood cognitive and visual development: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr. 2013; 97(3): 531-44.

Dennis CL, Dowswell T. Interventions (other than pharmacological, psychosocial or psychological) for treating antenatal depression. Cochrane Database Syst Rev. 2013 Jul 31; 7: CD006795.

Jans LA, Giltay EJ, Van der Does AJ. The efficacy of n-3 fatty acids DHA and EPA (fish oil) for perinatal depression. Br J Nutr. 2010; 104(11): 1577-85.

Szajewska H, Horvath A, Koletzko B. Effect of n-3 long-chain polyunsaturated fatty acid supplementation of women with low-risk pregnancies on pregnancy outcomes and growth measures at birth: a meta-analysis of randomized controlled trials. Am J Clin Nutr. 2006; 83(6): 1337-44.

Campoy C, Escolano-Margarit MV, Anjos T, Szajewska H, Uauy R. Omega 3 fatty acids on child growth, visual acuity and neurodevelopment. Br J Nutr. 2012; 107(Suppl 2): S85-106.

Jordan RG. Prenatal omega-3 fatty acids: review and recommendations. J Midwifery Womens Health. 2010; 55(6): 520-8.

Hibbeln JR, Davis JM, Steer C, Emmett P, Rogers I, Williams C, et al. Maternal seafood consumption in pregnancy and neurodevelopmental outcomes in childhood (ALSPAC study): an observational cohort study. Lancet. 2007; 369(9561): 578-85.

Wenstrom KD. The FDA’s new advice on fish: it’s complicated. Am J Obstet Gynecol. 2014. DOI: 10.1016/j.ajog.2014.07.048. [Epub ahead of print]

FAO/WHO. Report of the Joint FAO/WHO Expert Consultation on the Risks and Benefits of Fish Consumption. Rome, Food and Agriculture Organization of the United Nations. Geneva: World Health Organization; 2011.

National Research Council. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Washington, DC: National Academies Press; 2005.

Pacheco AH, Barreiros NS, Santos IS, Kac G. [Caffeine consumption during pregnancy and prevalence of low birth weight and prematurity: a systematic review]. Cad Saúde Pública. 2007; 23(12): 2807-19.

Jahanfar S, Jaafar SH. Effects of restricted caffeine intake by mother on fetal, neonatal and pregnancy outcome. Cochrane Database Syst Rev. 2013; 2: CD006965.

American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 462. Moderate caffeine consumption during pregnancy. Obstet Gynecol. 2010; 116(2 Pt 1): 467-8.

Moraes M,Sosa C, González G, Berta S, Borbonet D. Relación entre el consumo de mate en el embarazo con el peso al nacer. Arch Pediatr. 2014; 85(1): 18-24.

Dante G, Pedrielli G, Annessi E, Facchinetti F. Herb remedies during pregnancy: a systematic review of controlled clinical trials. J Matern-Fetal Neonatal Med Off J Eur Assoc Perinat Med Fed Asia Ocean Perinat Soc Int Soc Perinat Obstet. 2013; 26(3): 306-12.

Friedman JM. Teratology society: presentation to the FDA public meeting on safety issues associated with the use of dietary supplements during pregnancy. Teratology. 2000; 62(2): 134-7.

Hepner DL, Harnett MJ, Segal S, Camann W, Bader M, Tsen LC.Herbal medicinal products during pregnancy: are they safe? BJOG. 2002; 109(12): 1425-6.

Flak AL, Su S, Bertrand J, Denny CH, Kesmodel US, Cogswell ME. The association of mild, moderate, and binge prenatal alcohol exposure and child neuropsychological outcomes: a meta-analysis. Alcohol Clin Exp Res. 2014; 38(1): 214-26.

Guerria C, Rubiob V. Alcohol, embarazo y alteraciones infantiles. JANO. 2006; 1611: 29-33.

Evrard SG. Criterios diagnósticos del síndrome alcohólico fetal y los trastornos del espectro del alcoholismo fetal. Arch Argent Pediatr. 2010; 108(1): 61-7.

De-Regil LM, Fernández-Gaxiola AC, Dowswell T, Peña-Rosas JP. Effects and safety of periconceptional folate supplementation for preventing birth defects. Cochrane Database Syst Rev. 2010; (10): CD007950.

Mahomed K, Gülmezoglu AM. WITHDRAWN: Maternal iodine supplements in areas of deficiency. Cochrane Database Syst Rev. 2006; (3): CD000135.

Wang ZP, Shang XX, Zhao ZT. Low maternal vitamin B(12) is a risk factor for neural tube defects: a meta-analysis. J Matern Fetal Neonatal Med. 2012; 25(4): 389-94.

Koletzko B, Bauer CP, Bung P, Cremer M, Flothkötter M, Hellmers C, et al. German national consensus recommendations on nutrition and lifestyle in pregnancy by the ‘Healthy Start - Young Family Network’. Ann Nutr Metab. 2013; 63(4): 311-22.

National Research Council. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. Washington, D.C: National Academy Press. 1998.

National Research Council. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, D.C: National Academy Press; 2002.

Wang ZP, Shang XX, Zhao ZT. Low maternal vitamin B(12) is a risk factor for neural tube defects: a meta-analysis. J Matern Fetal Neonatal Med. 2012; 25(4): 389-94).

World Health Organization. Guideline: Daily Iron and Folic Acid Supplementation in Pregnant Women. Geneva: World Health Organization; 2012. Available from: http://www.ncbi.nlm.nih.gov/books/NBK132263/

Ministerio de Salud; UNICEF. Prevención de la anemia por deficiencia de hierro en niños y embarazadas. Manual del Participante. Argentina: Ministerio de salud; 2001.

Peña-Rosas JP, De-Regil LM, Dowswell T, Viteri FE. Intermittent oral iron supplementation during pregnancy. Cochrane Database Syst Rev. 2012; 7: CD009997.

Scanlon KS, Yip R, Schieve LA, Cogswell ME. High and low hemoglobin levels during pregnancy: differential risks for preterm birth and small for gestational age. Obstet Gynecol. 2000; 96(5 Pt 1): 741-8.

Ziaei S, Norrozi M, Faghihzadeh S, Jafarbegloo E. A randomised placebo-controlled trial to determine the effect of iron supplementation on pregnancy outcome in pregnant women with haemoglobin >13.2 g/dl. BJOG. 2007; 114(6): 684-8.

National Research Council. Dietary Reference Intakes for Calcium and Vitamin D. Committee to Review Dietary Reference Intakes for Vitamin D and Calcium. Washington, D.C. Food and Nutrition Board; 2011.

Hofmeyr GJ, Lawrie TA, Atallah AN, Duley L. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database Syst Rev. 2010; (8): CD001059.

Mori R, Ota E, Middleton P, Tobe-Gai R, Mahomed K, Bhutta ZA. Zinc supplementation for improving pregnancy and infant outcome. Cochrane Database Syst Rev. 2012; 7: CD000230.

Gebreselassie SG, Gashe FE. A systematic review of effect of prenatal zinc supplementation on birthweight: meta-analysis of 17 randomized controlled trials. J Health Popul Nutr. 2011; 29(2): 134-40.

Van den Broek N, Kulier R, Gülmezoglu AM, Villar J. Vitamin A supplementation during pregnancy. Cochrane Database Syst Rev. 2010; (11): CD001996.

Thorne-Lyman AL, Fawzi WW. Vitamin A and carotenoids during pregnancy and maternal, neonatal and infant health outcomes: a systematic review and meta-analysis. Paediatr Perinat Epidemiol. 2012; 26 (Suppl 1): 36-54.

López LB. Suplementación vitamínica y mineral en la embarazada ¿cuándo es necesaria? Actualización en Nutrición. 2009; 10(3): 195-202.

Haider BA, Bhutta ZA. Multiple-micronutrient supplementation for women during pregnancy. Cochrane Database Syst Rev. 2012; 11: CD004905.

Zerfu TA, Ayele HT. Micronutrients and pregnancy; effect of supplementation on pregnancy and pregnancy outcomes: a systematic review. Nutr J. 2013; 12: 20.

Christian P, Tielsch JM. Evidence for multiple micronutrient effects based on randomized controlled trials and meta-analyses in developing countries. J Nutr. 2012; 142(1): 173S-7.

Academy of Nutrition and Dietetics. Vegetarian nutrition (VN) evidence based nutrition guideline. Chicago (IL): Academy of Nutrition and Dietetics; 2011.

Siegfried N, Irlam JH, Visser ME, Rollins NN. Micronutrient supplementation in pregnant women with HIV infection. Cochrane Database Syst Rev. 2012; 3: CD009755.

López LB, Marigual M, Martín N, Mallorga M, Villagrán E, Zadorozne ME, et al. Characteristics of pica practice during pregnancy in a sample of argentine women. J Obstet Gynaecol. 2012; 32(2): 150-3.

Poy MS, Weisstaub A, Fernández S, Iglesias CE, Portela ML, López LB. Diagnóstico de pica durante el embarazo y deficiencia de micronutrientes en mujeres argentinas. Nutr Hosp. 2012; 27(3): 910-6.

Einarson TR, Piwko C, Koren G. Quantifying the global rates of nausea and vomiting of pregnancy: a meta analysis. J Popul Ther Clin Pharmacol. 2013; 20(2): e171-83.

Gadsby R, Barnie-Adshead AM, Jagger C. A prospective study of nausea and vomiting during pregnancy. Br J Gen Pract. 1993; 43(371): 245-8.

Matthews A, Dowswell T, Haas DM, Doyle M, O’Mathúna DP. Interventions for nausea and vomiting in early pregnancy. Cochrane Database Syst Rev. 2010; 9:CD007575.

Tosal B, Richart M, Pastor R, Cabrero J, Gutiérrez L, Luque M, et al. Evolución de los signos y síntomas gastrointestinales durante el embarazo y puerperio. Rev Invest Educ Enferm. 2001; 19: 113-9.

Tosal Herrero B, et al. Signos y síntomas gastrointestinales durante el embarazo y puerperio en una muestra de mujeres españolas. Aten Primaria. 2001; 28: 53-8.

Ebrahimi N, Maltepe C, Einarson A. Optimal management of nausea and vomiting of pregnancy. Int J Womens Health. 2010; 2: 241-8.

Verberg MFG, Gillott DJ, Fardan NAl, Grudzinskas JG. Hyperemesis gravidarum, a literature review. Hum Reprod Update. 2005; 11(5): 527-39.

Davis MJ. Nausea and vomiting of pregnancy: an evidence-based review. Perinat Neonatal Nurs. 2004; 18(4): 312-28.

Quinla JD, Hill DA. Nausea and vomiting of pregnancy. Am Fam Physician. 2003; 68(1): 121-8.

Niebyl JR. Clinical practice. Nausea and vomiting in pregnancy. N Engl J Med. 2010; 363(16): 1544-50.

Einarson A, Maltepe C, Boskovic R, Koren G. Treatment of nausea and vomiting in pregnancy: an updated algorithm. Can Fam Physician. 2007; 53(12): 2109-11.

American College of Obstetrics and Gynecology. ACOG (American College of Obstetrics and Gynecology) Practice Bulletin: nausea and vomiting of pregnancy. Obstet Gynecol. 2004; 103(4): 803-14.

Vazquez JC. Constipation, haemorrhoids, and heartburn in pregnancy. Clin Evid (Online). 2010; 2010. pii: 1411.

Jewell DJ, Young G. Interventions for treating constipation in pregnancy. Cochrane Database Syst Rev. 2001; (2): CD001142.

Bradley CS, Kennedy CM, Turcea AM, Rao SS, Nygaard IE. Constipation in pregnancy: prevalence, symptoms, and risk factors. Obstet Gynecol. 2007; 110(6): 1351-7.

Ponce J, Martínez B, Fernández A, Ponce M, Bastida G, Plá E, et al. Constipation during pregnancy: a longitudinal survey based on self-reported symptoms and the Rome II criteria. Eur J Gastroenterol Hepatol. 2008; 20(1): 56-61.

Meyer L, Peacock J, Martin J, Anderson R. Symptoms and health problems in pregnancy: their association with social factors, smoking, alcohol, caffeine and attitude to pregnancy. Pedriatr Perinat Epidemiol. 1994; 8: 145-55.

Alvarez L. Tratamiento farmacológico de enfermedades gastrointestinales durante el embarazo. Gastr Latinoam. 2007; 18(3): 286-98.

Cullen G, O’Donoghue D. Constipation and pregnancy. Best Pract Res Clin Gastroenterol. 2007; 21(5): 807-18.

Vazquez JC. Constipation, haemorrhoids, and heartburn in pregnancy. ClinEvid. 2010; 08: 1411.

Longo SA, Moore RC, Canzoner BJ, Robichaux A. Gastrointestinal Conditions during Pregnancy. Clin Colon Rectal Surg. 2010; 23(2): 80–9.

Derbyshire E, Davies J, Costarelli V. Diet, physical inactivity and the prevalence of constipation throughout and after pregnancy. Matern Child Nutr. 2006; 2(3): 127-34.

Derbyshire E. The importance of adequate fluid and fibre intake during pregnancy. Nurs Stand. 2007; 21(24): 40-3.

Artal R, O’Toole M. Guidelines of the American college of obstetricians and gynaecologists for exercise during pregnancy and the postpartum period. Br J Sports Med. 2003; 37(1): 6–12.

Calvo EB, López LB. Reference Charts for Anthropometric Changes during Pregnancy. In: Handbook of Anthropometry. Physical Measures of Human Form in Health and Disease. Victor R. Preedy, Editor. Springer, New York. 2012: 999-1019.

Barker D. In utero programming of chronic disease. Clin Sci (Lond). 1998; 95(2): 115-28.

Institute of Medicine; National Research Council. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press; 2009.

Calvo E, López LB, Balmaceda Y, Barrientos E, Berlingueres S, Cámera K, Garciarena S, González K, Quintana L, Poy M. Reference charts for weight gain and body mass index during pregnancy obtained from a healthy cohort. J Mater Fetal Neonatal Med. 2009; 22(1): 36-42.

López LB, Calvo EB, Poy MS, Balmaceda Y, Cámera K. Changes in skinfolds and mid-upper arm circumference during pregnancyin argentine women. Matern Child Nutr. 2011; 7(3): 253-62.




DOI: http://dx.doi.org/10.14306/renhyd.18.4.113

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