Estado nutricional materno e amamentação: associação e relação com o estado nutricional da criança aos 12 e 24 meses de idade

Abstract

Excess weight is considered a global epidemic, reaching about 40% of the world's population. In women of childbearing age, this frequency can reach up to approximately 30%. Evidences indicate that women with prepregnancy overweight and obesity are less likely to breastfeed and when breastfeeding the duration is lower compared to prepregnancy eutrophic, or even low weight, mothers. Another hypothesis is that the maternal prepregnancy body mass index (BMI) may influence the child's BMI still in early childhood (up to 24 months of age). Thus, the objective of this thesis was to understand the association between maternal nutritional status and initiation and duration of breastfeeding and the nutritional status of the child at 12 and 24 months of age. To meet the specific objectives of the thesis, a systematic review of the literature was conducted on prepregnancy overweight and obesity and cessation of exclusive breastfeeding, being a meta-analysis possible to be performed (combined measure) of these studies. This review allowed us to identify that prepregnancy overweight and obesity was associated with the early cessation of exclusive breastfeeding (before six months of age), even though publication bias was observed (only positive results published). Two additional original studies were developed on the subject. The first study aimed to identify the association between prepregnancy overweight and obesity and the breastfeeding pattern at three months of age, and the duration of breastfeeding up to 12 months. This article was carried out with data from the four Pelotas birth cohorts (1982, 1993, 2004 and 2015) and showed that in the 1982, 1993 and 2004 cohorts, the association of prepregnancy BMI and the breastfeeding patterns up to three months of age and the duration until the 12 months were not found. However, this association was present in the 2015 cohort, where children whose mothers had higher prepregnancy BMI were more likely not to be breastfed exclusively at three months and had shorter breastfeeding duration evaluated at 12 months of age. Finally, longitudinal data, only from the 2015 cohort, were used to evaluate the association between maternal prepregnancy BMI and BMI of the child at 24 months of age, as well as the mediator role of exclusive breastfeeding, food introduction and BMI of the child at 12 months of age in the relationship between maternal prepregnancy BMI and BMI of the child at 24 months. The results of this study suggest that the maternal prepregnancy BMI acts directly on the child’s BMI both at 12 and 24 months of age, showing that children whose mothers were overweight and obese during prepregnancy had higher odds of having excess weight (BMI/age, in z-score, ≥ 2 standard deviation) and, moreover, this association operates especially by BMI of the child at 12 months of age. As a conclusion of this thesis, it is important to emphasize that the prevention of overweight and obesity, in the previous and early stages of pregnancy, could be a health policy considering the influence of these conditions on breastfeeding and in the child’s BMI. Several investments to increase breastfeeding, especially exclusive breastfeeding, have been employed over the years. Therefore, it is important to know and understand the factors that can still affect this beneficial behavior to maternal-child health.