Avaliação do crescimento fetal e da velocidade média de crescimento de crianças até seis meses de vida com base numa coorte de nascimento, 2018

Abstract

Introduction: The first six months of life are considered the moment of greater growth rate and, therefore, a critical period. Poor maternal and child nutrition, including malnutrition and overweight, are global problems. Disorders of fetal growth represent an important public health problem associated with subsequent growth and development. Changes in the pattern of growth after birth are related to infant morbidity and mortality and to the development of chronic diseases at subsequent ages. Objectives: To evaluate the fetal growth and the growth rate of children up to six months of age. Methods: This is a cohort study of the birth of children who were followed up to six months of age. Socioeconomic, characteristics of pregnancy/childbirth/puerperium, feeding practices of the child, difficulty of the mother in breastfeeding, use of pacifiers, supplementation and morbidity were investigated. Fetal growth was evaluated using the weight (g)/head circumference (cm) ratio at birth. Children‟s weight gain rain (grams/day), length gain (centimeters/month) and cephalic perimeter gain (centimeters/month) were calculated from birth to the 1st, 2nd and 6th months and compared accordingly to the variables of interest. Results: The mean weight, length and cephalic perimeter were lower among children classified with disproportion weight/cephalic perimeter, adjusted for the sex of the child. Mean weight, length and cephalic perimeter were lower among infants with disproportionate weight/head circumference ratio, independently of sex. The common exposures that contributed negatively to the growth rate were females and the difficulty of breastfeed. Cephalic and weight rates were influenced by the presence of severe mental disorder in the mother, moderate/severe food insecurity, porridge consumption and non-follow-up of the indicator through the Child Health Handbook; while cephalic and length rates were influenced by maternal non-vaccination against tetanus. Also, there was a deceleration in the growth rate if: i. the mother used alcohol during pregnancy, delivery was cesarean, the child was fed inadequately (mixed/predominant breastfeeding, use of infant formula) and had episodes of diarrhea/vomiting, for the cephalic perimeter; ii. prenatal care was inadequate, for the weight; iii. the mother was of short stature and the child used a pacifier, for the length. Conclusions: The weight/head circumference ratio is a useful indicator in the evaluation of fetal growth, indicating lower cephalic perimeter, weight and length means among disproportionate children. In the longitudinal evaluation of children, it is verified that the growth rate is influenced by factors, most of them modifiable, which have in common the relation with the breastfeeding of the infant.