The importance of Nutrology in pregnancy

Abstract

For many years, concern about nutrition during pregnancy was closely linked to the well-being of the fetus, mother and prevention of perinatal mortality. In 2010, the number of newborn deaths up to 4 weeks of life was four million worldwide, with an unequal distribution among developed and developing countries (GLASSMAN ET AL. 2010). Mortality in the neonatal period, which comprises the period between birth and 28 days of life of the newborn, is one of the best markers of the quality of care for pregnant women in the neonatal period. Congenital malformations, prematurity, low birth weight, cancer and maternal complications related to childbirth appear in the neonatal mortality list. Although these causes are multifactorial in nature, all have in their genesis some potentially modifiable risk factor associated with maternal nutrition. More recently, the concern with nutrition in pregnancy has gained an added chapter, which is the prevention of chronic diseases in the future of children (MATS, 2011). Between 2008 and 2013, epidemiologists met to compile the Lancet Series. The goal was to study the 178 million malnourished children under 5 years of age. Early in the studies, epidemiologists identified that 32 million malnourished children were born with intrauterine growth restriction. The number, besides being significant, brought concern about what the future of these children would look like in terms of growth, neuropsychomotor development, chronic diseases and the impact on human capital. Throughout the studies, it has been proven that the impact of malnutrition during pregnancy has an intimate correlation not only adverse events in the peripartum period, but with chronic degenerative diseases such as diabetes mellitus, systemic arterial hypertension, obesity and even cancer ( The next stage of epidemiologists was to identify a possible intervention window, where risk factors could be identified and corrected, in order to reverse the chronic damage that malnutrition irreversibly establishes in the physical and cognitive health of the child (MARCINIAK, 2017) This intervention period, known as the golden period, was given the name 1000 days. The 1000 days, also known as the Golden Interval, is the period that runs from the first day of pregnancy to the two years of age. More recently, studies have spoken in 1100 days, extending this intervention window to 100 days before conception. The 1000 days not only include nutritional strategies, but these are certainly the ones with the greatest impact on long-term disease prevention. What the Lancet series advocate is that proper nutrition during pregnancy and during the first two years of life can not only impact the individual, but an entire society. GLASSMAN et al. (2010) published a projection that if nothing is done regarding the reduction of chronic degenerative diseases in Brazil, in 20 to 30 years public health spending will double. The Lancet series on malnutrition during pregnancy and childhood can prove that the improvement in the health of pregnant women and newborns brings social and economic benefits, which could change the course of society's rampant evolution to chronic degenerative disease. Therefore, it is a great opportunity for the individual and society and a great responsibility for health teams to establish adequate nutrition in the thousand days. Given the great importance that nutrition in pregnancy has in determining a healthy childhood and adult life, it is to be expected that this is a subject of fundamental importance in prenatal care. However, a study conducted in the state of Rio de Janeiro found failures in nutritional follow-up throughout prenatal care, reflecting the little importance given to nutrition during pregnancy. In this study, 90.7% of the pregnant women's portfolios had no record on the BMI graph per week of gestation. Pre-gestational weight and height measured were recorded in 65.9% and 57.7% of prenatal cards , respectively (NIQUINI, 2012). These are incompatible data with the objective of reversing causes of prenatal mortality as well as reversing chronic degenerative disease. It is of great importance to reverse the current situation in Brazil, which has an expressive number of maternal malnutrition, anemia, vitamin A and micronutrient deficiency, hypertensive syndromes and gestational diabetes. The first step to reverse the morbidity and mortality of mother and baby, as well as to decrease the illness of the population is to give adequate preconception care. This chapter aims to address these prenatal nutritional care, as well as each nutritional aspect associated with the prevention of chronic degenerative disease.