Suplementação de cálcio em baixa dose para prevenção de pré-eclampsia: ensaio clínico randomizado tipo cluster
| Ano de defesa: | 2018 |
|---|---|
| Autor(a) principal: | |
| Orientador(a): | |
| Banca de defesa: | |
| Tipo de documento: | Tese |
| Tipo de acesso: | Acesso aberto |
| Idioma: | por |
| Instituição de defesa: |
Universidade Federal de São Paulo (UNIFESP)
|
| Programa de Pós-Graduação: |
Não Informado pela instituição
|
| Departamento: |
Não Informado pela instituição
|
| País: |
Não Informado pela instituição
|
| Palavras-chave em Português: | |
| Link de acesso: | https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=6907465 https://repositorio.unifesp.br/handle/11600/52494 |
Resumo: | Background: Gestational hypertensive syndromes are the main cause of direct maternal mortality in Amazonas and Brazil. The diet low in calcium (<900 mg elemental calcium / day), as is typical in Amazonas, increases the risk of developing hypertensive syndromes. There is evidence of high quality that supplementation of 1.52.0 g of elemental calcium / day from the start of the second trimester of pregnancy significantly reduces the incidence of hypertensive syndromes and maternal morbidity and mortality. However, this dose is associated with gastrointestinal symptoms that may affect supplement acceptance and logistical problems for the storage and distribution of the input. Some studies suggest that supplementation of low doses of Ca (<1 g / day) would have similar effectiveness as high doses (> 1 g / day). However, there are few studies on this type of supplementation. There are also few studies on the possibility of increasing the dietary intake of Ca from pregnant women through educational interventions during prenatal care. Aim: The main objective of this study was to evaluate the effectiveness and adverse effects of supplementation of Ca 500 mg / day started in the second trimester of gestation associated with a nutritional educational intervention versus an isolated nutritional educational intervention in the prevention of gestational hypertensive syndromes. Method: Randomized cluster trial involving 1020 pregnant women undergoing prenatal care in 10 basic health units (UBS) in Manaus, Amazonas. All pregnant women were invited to participate in three nutritional educational sessions in their respective UBS. Pregnant women in the 5 UBS randomized to supplementation started daily taking 1 tablet containing 500 mg Ca from the 16th to the 20th week until the 36th week. All participants were followed up until delivery. Primary outcomes were the incidence of preeclampsia / eclampsia, gestational hypertensive syndromes with or without proteinuria, and gastrointestinal adverse events. Results: A total of 1020 pregnant women were recruited and the gestational outcomes of 964 (94.5%) could be analyzed. The risk of PE / E was 57% lower (RR 0.43, 95% CI 0.28 to 0.67, p = 0.001), and the risk of gestational hypertensive syndromes with or without proteinuria was 47% lower (RR 0 , 53, 95% CI 0.43 to 0.70, p = 0.001) than the unsupplemented group. However, the risk of gastrointestinal symptoms was 41% higher RR 1.4 IC 95% 1.03 to 1.92, p = 0.043) in the supplemented group. Mean basal dietary intake of the 1020 participants was 636 mg (SD: 367) and 70% had an insufficient daily intake of Ca (<900 mg / day). After participating in an educational session, the mean daily intake of Ca increased to 742.6 (391.2) mg / day, reaching 821.9 (387.9) mg / day after two educational sessions (p = 0.001). However, only 34.6% and 41.3% of the pregnant women had an adequate intake of Ca after participating in one and two educational sessions, respectively. Conclusion: Ca supplementation 500 mg / day from the 2nd trimester along with a nutritional educational intervention is more effective than just an educational nutritional intervention in the prevention of gestational hypertension syndromes. |