Composição nutricional do leite humano e sua associação com fatores maternos e perinatais

Marano, Daniele; Melo, Raquel Ximenes; Silva, Danielle Aparecida da; Vilarim, Marina Machado; Moreira, Maria Elisabeth Lopes

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Brasil

Revista Paulista de Pediatria

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Brasil

Español English

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Sumário

ORIGINAL ARTICLE • Rev. paul. pediatr. 42 • 2024 • https://doi.org/10.1590/1984-0462/2024/42/2023001 copiar

Composição nutricional do leite humano e sua associação com fatores maternos e perinatais

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

Objetivo:

Avaliar a influência de fatores maternos e perinatais na composição nutricional do leite humano.

Métodos:

Estudo transversal, realizado entre novembro de 2018 e janeiro de 2020, com 181 doadoras selecionadas em Unidades Terciárias de Saúde do Sistema Único de Saúde de um Posto de Coleta e cinco Bancos de Leite Humano. Foram coletados dados das variáveis maternas e dos recém-nascidos por meio de questionário padronizado. Estar apta para ser doadora em um Banco de Leite Humano e produzir leite maduro foram os critérios de elegibilidade para participar do estudo. As amostras de leite com acidez Dornic acima de 8° D foram excluídas. Os macronutrientes do leite humano, variáveis dependentes (carboidratos, proteínas, lipídeos, energia total) foram analisados pela técnica de espectroscopia de transmissão no infravermelho médio com o Miris Human Milk Analyzer™. Os fatores maternos e perinatais foram as variáveis independentes.

Resultados:

Mulheres com obesidade pré-gestacional e ganho de peso gestacional acima do recomendado apresentaram menor concentração proteica em relação às eutróficas (mediana=0,8, intervalo interquartil [IQR]: 0,7–0,9 vs. mediana=0,8, IQR: 0,8–1,0) e aquelas com ganho de peso gestacional adequado (mediana=0,8, IQR: 0,7–0,9 vs. mediana=0,9, IQR: 0,8–1,0), respectivamente. Os demais fatores analisados (hábitos maternos, comorbidades, fatores perinatais) não se associaram com a composição nutricional do leite humano.

Conclusões:

A avaliação dos fatores associados à composição nutricional do leite humano é de extrema importância para auxiliar os cuidados pós-parto. A obesidade pré-gestacional e o ganho de peso gestacional inadequado foram os únicos fatores estatisticamente associados com a composição nutricional do leite humano por terem impactado o seu teor de proteína.

Palavras-chave:
Leite humano; Pós-parto; Perinatal; Materno; Maternidade; Recém-nascido

	Average	Median	Percentiles 25–75	SD
Lipids (g/100 mL)	2.7	2.5	1.6–3.5	1.5
Carbohydrates (g/100 mL)	7.4	7.7	7.2–7.9	1.0
Proteins (g/100 mL)	0.9	0.8	0.8–1.0	0.3
Calories (kcal/100 mL)	59.2	57.0	49.5–67.0	14.3

		Average (SD)	n	%
Maternal age (years)		33.1±5.1	–	–
Schooling	High school incomplete	–	3	1.7
	High school complete	–	26	14.4
	University incomplete	–	8	4.4
	University complete	–	144	79.6
Skin color	White	–	116	64.1
	Interracial	–	47	26
	Black	–	13	7.2
	Yellow	–	5	2.8
Marital status	Single	–	14	7.7
	Married	–	123	68
	Stable union	–	43	23.8
	Divorced	–	1	0.6
Prenatal care service	Public	–	27	14.9
Prenatal care service	Private	–	154	85.1
Alcohol during pregnancy	Yes	–	26	14.4
Smoking during pregnancy	No	–	177	97.8
Drug consumption during pregnancy	No	–	180	99.4
Alcohol whilst breastfeeding	No	–	160	88.4
Smoking whilst breastfeeding	No	–	180	99.4
Pre-gestational hypertension	No	–	178	98.3
Hypertension during pregnancy	No	–	168	92.8
Diabetes mellitus pre-gestational	No	–	181	100
Diabetes mellitus during pregnancy	No	–	175	96.7
Pre-gestational nutritional status (WHO¹⁶16. World Health Organization [homepage on the Internet]. A healthy lifestyle – WHO recommendations [cited 2023 July 26]. Geneva: WHO; 2010. Available from: https://www.who.int/europe/news-room/fact-sheets/item/a-healthy-lifestyle---who-recommendations https://www.who.int/europe/news-room/fac... )	Low weight	–	10	5.5
	Adequate	–	108	59.7
	Overweight	–	46	25.4
	Obese	–	17	9.4
Gestational weight gain (IOM¹⁵15. Institute of Medicine, National Research Council, Committee to Reexamine IOM Pregnancy Weight Guidelines, Rasmussen KM, Yaktine AL. Weight gain during pregnancy: reexamining the guidelines. Washington: National Academies Press; 2009. https://doi.org/10.17226/12584 https://doi.org/10.17226/12584... )	Low	–	55	30.4
	Adequate	–	59	32.6
	Above	–	67	37
Sex	Female	–	98	54.1
Sex	Male	–	83	45.9
Type of delivery	Normal	–	76	41.9
	Cesarean	–	102	56.4
	Forceps	–	3	1.7
Birth weight (g)	–	3254.8±501.0	–	–
Gestational age (weeks)	–	39.1±1.4	–	–

		n	Lipids	p-value	Carbohydrates	p-value	Proteins	p-value	Calories	p-value
		n	Median (percentiles 25–75)	p-value	Median (percentiles 25–75)	p-value	Median (percentiles 25–75)	p-value	Median (percentiles 25–75)	p-value
Alcohol during pregnancy	No	155	2.4 (1.6–3.4)	0.862	7.7 (7.1–7.9)	0.842	0.8 (0.8–1.0)	0.730	57.0 (50.0–66.0)	0.762
Alcohol during pregnancy	Yes	26	2.7 (1.3–3.6)	0.862	7.8 (7.2–7.8)	0.842	0.8 (0.8–1.0)	0.730	58.5 (48.0–69.0)	0.762
Alcohol during breastfeeding	No	160	2.5 (1.6–3.5)	0.969	7.7 (7.1–7.9)	0.533	0.8 (0.8–1.0)	0.379	57.0 (50.0–66.5)	0.950
Alcohol during breastfeeding	Yes	21	2.6 (1.3–3.4)	0.969	7.8 (7.3–7.9)	0.533	0.8 (0.8–0.9)	0.379	59.0 (49.0–67.0)	0.950
Smoking during pregnancy	No	177	2.5 (1.6–3.4)	0.284	7.7 (7.2–7.9)	0.739	0.8 (0.8–1.0)	0.563	57.0 (50.0–67.0)	0.453
Smoking during pregnancy	Yes	4	3.4 (2.4–5.4)	0.284	7.2 (6.4–8.8)	0.739	0.9 (0.8–2.6)	0.563	61.0 (54.5–96.0)	0.453
Smoking during breastfeeding	No	180	2.5 (1.6–3.4)	–	7.7 (7.2–7.9)	–	0.8 (0.8–1.0)	–	57.0 (49.5–66.5)	–
Smoking during breastfeeding	Yes	1	7.4	–	9.7	–	4.1	–	130.0	–
Pre-gestational hypertension	No	178	2.5 (1.6–3.5)	0.998	7.7 (7.2–7.9)	0.475	0.8 (0.8–1.0)	0.722	57.0 (49.0–67.0)	0.907
Pre-gestational hypertension	Yes	3	2.5 (2.2–2.8)	0.998	7.9 (7.0–8.1)	0.475	0.8 (0.7–1.0)	0.722	59.0 (52.0–64.0)	0.907
Hypertension during pregnancy	No	168	2.5 (1.6–3.5)	0.663	7.7 (7.2–7.9)	0.648	0.8 (0.8–1.0)	0.981	57.0 (50.0–67.0)	0.703
Hypertension during pregnancy	Yes	13	2.5 (1.7–3.0)	0.663	7.6 (7.2–8.0)	0.648	0.8 (0.8–1.0)	0.981	59.0 (49.0–65.0)	0.703
Pre-gestational diabetes mellitus	No	181	2.5 (1.6–3.4)	–	7.7 (7.2–7.9)	–	0.8 (0.8–1.0)	–	57.0 (50.0–67.0)	–
Pre-gestational diabetes mellitus	Yes	0	–	–	–	–	–	–	–	–
Diabetes mellitus during pregnancy	No	175	2.5 (1.6–3.5)	0.622	7.7 (7.1–7.9)	0.805	0.8 (0.8–1.0)	0.779	57.0 (49.0–67.0)	0.692
Diabetes mellitus during pregnancy	Yes	6	3.1 (1.7–3.3)	0.622	7.7 (7.2–7.9)	0.805	0.9 (0.8–0.9)	0.779	62.0 (51.0–66.0)	0.692
Gestational age (weeks)	≥37	172	2.5 (1.6–3.5)	0.371	7.7 (7.2–7.9)	0.593	0.8 (0.8–1.0)	0.398	57.0 (49.5–67.0)	0.396
	34–36.9	8	2.9 (1.9–3.7)		7.6 (7.2–7.7)		1.0 (0.7–1.0)		60.5 (53.5–65.5)
	<34	1	1.1		7.4		0.7		44.0
Sex of the newborn	Female	98	2.5 (1.6–3.4)	0.606	7.7 (7.1–7.9)	0.858	0.8 (0.8–1.0)	0.996	56.5 (49.0–67.0)	0.521
Sex of the newborn	Male	83	2.5 (1.6–3.7)	0.606	7.7 (7.2–7.9)	0.858	0.8 (0.8–0.9)	0.996	58.0 (51.0–68.0)	0.521

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[1] *Corresponding author. E-mail: danielemarano@yahoo.com.br (D. Marano)