Associação entre insegurança alimentar, determinantes sociais e desfechos nutricionais em mulheres grávidas: revisão e metanálise

Demétrio, Fran; Teles, Carlos Antônio de Souza; Santos, Djanilson Barbosa dos; Pereira, Marcos

doi:10.1590/1413-81232020257.24202018

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ARTICLE • Ciênc. saúde coletiva 25 (7) • Jul 2020 • https://doi.org/10.1590/1413-81232020257.24202018 copiar

Associação entre insegurança alimentar, determinantes sociais e desfechos nutricionais em mulheres grávidas: revisão e metanálise

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

O estudo objetiva analisar a associação entre insegurança alimentar, determinantes sociais e estado nutricional de mulheres gestantes por meio de uma revisão sistemática e metanálise. As buscas de artigos ocorreram em cinco bases eletrônicas. Determinantes sociais (raça, escolaridade, participação em programa social) e estado nutricional (IMC pré-gestacional, ganho de peso gestacional, anemia) foram analisados em relação à situação de IA. Em cada estudo, a frequência de insegurança alimentar foi coletada para calcular a medida sumário- razão de prevalência (RP) e seu intervalo de confiança de 95%(IC95%). Foram selecionados 26 artigos. Observou-se elevada ocorrência de IA em gestantes pretas (RP:1,83; IC 95% 1,08-3.10), naquelas com participação em programas de proteção social (RP = 1.43; IC 95%= 1.02- 2.01) e com baixo nível de escolaridade (RP = 2.73; IC 95%= 1.68-4.43). O fato de a gestante possuir companheiro protegeu contra IA (RP = 0.61; IC 95%= 0.40-0.95). A experimentação da IA elevou a chance de sobrepeso (RP = 1.57; IC 95% = 1.29-1.91) e de obesidade (RP = 1.47; IC 95% = 1.15-1.87), assim como o ganho excessivo (RP = 1.42; IC 95% = 1.10-1.82) e inadequado (RP = 1.47; IC 95%= 1.09-1.97) de peso na gestação. Iniquidades sociais estão associadas a IA em gestantes.

Palavras-chave
Determinantes sociais da saúde; Mulheres grávidas; Segurança alimentar e nutricional

Database	Search strategy	Items found
Medline/PubMed http://www.ncbi.nlm.nih.gov/pubmed	"food insecurity"[All Fields] OR "food security"[All Fields]) AND ("pregnant women"[All Fields] OR "women"[All Fields]) AND (("2000/01/01"[PDAT] : "3000/12/31"[PDAT]) AND "humans"[MeSH Terms])	524
Web of science http://appswebofknowledge.ez	(("food insecurity" OR "food security" ) AND ("pregnant women" OR "women")) OR LIMIT-TO: ( 2016 OR 2010 OR 2004 OR 2015 OR 2007 OR 2002 OR 2014 OR 2009 OR 2001 OR 2013 OR 2008 OR 2012 OR 2006 OR 2000 OR 2011 OR 2003 OR 2017 OR 2005 )	1.328
Scopus: http://www.scopus.com/	TITLE-ABS-KEY ( "food insecurity" OR "food security" AND "pregnant women" OR women ) AND ( LIMIT-TO ( PUBYEAR , 2017 ) OR LIMIT-TO ( PUBYEAR , 2016 ) OR LIMIT-TO ( PUBYEAR , 2015 ) OR LIMIT-TO ( PUBYEAR , 2014 ) OR LIMIT-TO ( PUBYEAR , 2013 ) OR LIMIT-TO ( PUBYEAR , 2012 ) OR LIMIT-TO ( PUBYEAR , 2011 ) OR LIMIT-TO ( PUBYEAR , 2010 ) OR LIMIT-TO ( PUBYEAR , 2009 ) OR LIMIT-TO ( PUBYEAR , 2008 ) OR LIMIT-TO ( PUBYEAR , 2007 ) OR LIMIT-TO ( PUBYEAR , 2006 ) OR LIMIT-TO ( PUBYEAR , 2005 ) OR LIMIT-TO ( PUBYEAR , 2004 ) OR LIMIT-TO ( PUBYEAR , 2003 ) OR LIMIT-TO ( PUBYEAR , 2002 ) OR LIMIT-TO ( PUBYEAR , 2001 ) OR LIMIT-TO ( PUBYEAR , 2000 ) ) AND ( LIMIT-TO ( DOCTYPE , "ar" ) OR LIMIT-TO ( DOCTYPE , "re" ) )	1193
Science Direct: http://www.sciencedirect.com/	food insecurity AND pregnant women OR women	1.329
Lilacs	food insecurity AND pregnant women OR women	8

Inclusion criteria	Exclusion criteria
Population: pregnant women at any gestational age	Studies focusing on other group
Study identified as cross-sectional, cohort, and case-control, intervention.	Qualitative sudies
Portuguese, English, and Spanish languages	Types of documents were not considered: editorials, letters, articles of opinion, comments, management reports, official documents from national and international programs and books
Published from 1st January 2010 to 10th July 2017 (online or in print)
Outcomes: food insecurity in pregnant nutritional outcomes

Authors	Question Numbers							Overall Judgment on Risk of Bias
Authors	Q1	Q2	Q3	Q4	Q5	Q6	Q7
Carmichael et al., 2007	+	+	+	-	+	+	+	High
Hromi-Fiedler et al., 2011	+	+	+	-	?	+	+	High
Laraia et al., 2006	+	+	+	-	+	+	+	High
Laraia et al., 2010	+	+	+	-	+	+	+	High
Laraia et al., 2013	?	+	+	-	+	+	+	High
López-Sáleme et al., 2012	-	+	+	+	+	+	-	High
Marano et al.,2014	+	+	+	-	+	+	+	High
Park et al., 2014	-	+	+	+	+	+	+	High
Quintero et al., 2010	+	+	+	-	+	-	-	High
Stevens et al., 2016	+	+	+	+	+	+	-	High
Tsai et al.,2016	+	+	+	+	+	+	+	Low
Zapata-López et al., 2013	+	+	+	+	+	+	+	Low
Gambda et al., 2016	+	+	+	+	+	+	+	Low
Eaton et al.,2014	?	+	+	+	+	+	-	High
Heberlein et al.,2016	+	+	+	_	+	+	+	High
Hojaji et al.,2015	+	+	+	_	+	+	+	High
Jebena et al.,2015	+	+	+	+	+	+	+	Low
Laraia et al.,2015	+	+	+	+	+	+	+	Low
Morales et al.,2016	+	+	+	+	-	-	-	High
Na et al.,2016	+	+	+	-	+	+	+	High
Natamba et al.,2014	+	+	+	?	+	+	+	Moderate
Oliveira et al.,2017	+	+	+	+	+	+	+	Low
Power et al.,2017	+	+	+	+	+	+	+	Low
Rasty et al.,2015	+	+	+	-	+	+	+	High
Yadegari et al.,2017	+	+	+	+	+	+	-	High
Demetrio et al.,2017	+	+	+	+	+	+	+	Low

Authors	Design/ country of origin	Sample	Evaluation of food insecurity (FI)	Exposure(s)	Outcome
Park and Eicher-Miller, 2014¹1 Park CY, Eicher-Miller HA. Iron deficiency is associated with food insecurity in pregnant females in the United States: National Health and Nutrition Examination Survey 1999-2010. 1999-2010. J Acad Nutr Diet 2014; 114(12):1967-1973.	Cross-sectional, United States	1.045 pregnant females	HFSSM	FI	Iron deficiency anemia (ID)
Carmichael et al., 2007¹⁰10 Carmichael SL, Yang W, Herring A, Abrams B, Shaw GM. Maternal food insecurity is associated with increased risk of certain birth defects. J Nutr 2007; 137(9):2087-2092.	Case-control, Los Angeles, San Francisco, and Santa Clara, United States	1.189 case mothers and 695 control mothers	HFSSM-6SF	FI	Congenital defects
Hromi-Fiedler et al., 2011¹⁶16 Hromi-Fiedler A, Bermudez-Millan A, Segura-Perez S, Perez-Escamilla R. Household food insecurity is associated with depressive symptoms among low-income pregnant Latinas. Matern Child Nutr 2011; 7(4):421-430.	Cross-sectional, Hartford, Connecticute, United States	135 low income pregnant Latinas, 25.24 years (SD = 5.65)	HFSSM	Household food insecurity	prenatal depressive symptoms- EPDS
Laraia et al., 2006¹⁷17 Laraia B, Siega-Riz AM, Gundersen C, Dole N. Psychosocial factors and socioeconomic indicators are associated with household food insecurity among pregnant women. J Nutr 2006; 136(1):177-182.	Cohort, University of North Carolina Hospitals,United States	606 pregnant women, 16–45 years	HFSSM	Economic / demographic and psychosocial predictors	FI
Laraia et al., 2010¹⁸18 Laraia BA, Siega-Riz AM, Gundersen C. Household food insecurity is associated with self-reported pregravid weight status, gestational weight gain, and pregnancy complications. J Am Diet Assoc 2010; 110(5):692-701.	Cohort, United States	810 pregnant women, 27.3 years (DP =5.5)	CSFM	FI	Gestational complications
Laraia et al., 2013¹⁹19 Laraia B, Epel E, Siega-Riz AM. Food insecurity with past experience of restrained eating is a recipe for increased gestational weight gain. Appetite 2013; 65:178-184.	Cohort, North Carolina, United States	1041 pregnant women, 29.3 years (DP = 5.5)	CSFM	FI/ food restriction / pregestational weight retention	Gestational weight gain
López-Sáleme et al., 2012²⁰20 López-Sáleme R, Díaz-Montes CE, Bravo-Aljuriz L, Londoño-Hio NP, Salguedo-Pájaro MDC, Camargo-Marín CC, Osorio-Espitia E. Seguridad alimentaria y estado nutricional de las mujeres embarazadas en Cartagena, Colombia, 2011. Rev Salud Pública 2012; 14(2):200-212.	Cross-sectional, Cartagena, Colombia	413 pregnant women	ELCSA	FI	Gestational nutritional status
Quintero Tabares et al., 2010²¹21 Quintero Tabares R, Muñoz Astudillo MN, Alvarez Sierra LE, Medina Perea GA. Estado nutricional y seguridad alimentaria en gestantes adolescentes. Pereira, Colombia, 2009. Investig y edicación en Enfermería 2010; 28(2):204-213.	Cross-sectional, Pereira, Colombia	150 pregnant women, median 17 years	ELCSA	-	-
Stevens et al., 2017²²22 Stevens B, Watt K, Brimbecombe J, Clough A, Judd J, Lindsay D. The role of seasonality on the diet and household food security of pregnant women living in rural Bangladesh: A cross-sectional study. Public Health Nutr 2017; 20(1):121-129.	Cross-sectional, northern Bangladesh.	288 pregnant women, 25.3(SD = 5.7)	HFIAS	Seasonality	Household food security, dietary diversity and nutritional status
Tsai et al., 2016²³23 Tsai AC, Tomlinson M, Comulada WS, Rotheram-Borus MJ. Food insufficiency, depression, and the modifying role of social support: Evidence from a population-based, prospective cohort of pregnant women in peri-urban South Africa. Soc Sci Med 2016; 151:69-77.	Longitudinal, three-year cluster-randomized trial, Cape Town, South Africa	1238 pregnant women ,	HFIAS	FI	Depression symptom severity
Zapata-López and Restrepo-Mesa, 2013²⁴24 Zapata-López N, Restrepo-Mesa SL. Factors associated with maternal body mass index in a group of pregnant teenagers, Medellin, Colombia. Cad Saude Publica 2013; 29(5):921-934.	Cross-sectional, Medellín, Colombia	294 pregnant teenager, 17,3 years (DP: 1,5)	ELCSA	Socio-economic / food safety / health factors	Anthropometric measures
Gamba et al., 2016²⁵25 Gamba R, Leung CW, Guendelman S, Lahiff M, Laraia BA. household food insecurity is not associated with overall diet quality among pregnant women in NHANES 1999-2008. Matern Child Health J 2016; 20(11):2348-2356.	Cross-sectional study, United States	1158 pregnant women ≥ 20- >30	HFSSM	Household food security status	Diet quality
Eaton et al., 2014²⁶26 Eaton LA, Pitpitan E V, Kalichman SC, Sikkema KJ, Skinner D, Watt MH, Pieterse D, Cain DN. Food insecurity and alcohol use among pregnant women at alcohol-serving establishments in South Africa. Prev Sci 2014; 15(3):309-317.	Prospective cohort, Cape Town, South Africa	95 pregnan women 29.85 (SD = 9.73)	HFSSM	Alcohol Use	Food Insecurity
Hojaji et al., 2015²⁷27 Hojaji E, Zavoshy R, Noroozi M, Jahanihashemi H, Ezzedin N. Assessment of household food security and its relationship with some pregnancy complications. J Maz Univ Med Sci 2015; 25(123):91-102.	Cross-sectional study,Tehran.	700 mothers 29 (SD = 5)	HFSSM	Household food security	Pregnancy complications
Jebena et al., 2015²⁸28 Jebena MG, Taha M, Nakajima M, Lemieux A, Lemessa F, Hoffman R, Tesfaye M, Belachew T, Workineh N, Kebede E, Gemechu T, Tariku Y, Segni H, Kolsteren P, al’Absi M. Household food insecurity and mental distress among pregnant women in Southwestern Ethiopia: a cross sectional study design. BMC Pregnancy Childbirth 2015; 15:250.	Cross-sectional, Oromia Regional State, southwest Ethiopia	2,987 pregnant women 25.5 (Sd = 4.9)	HFIAS	Household food security	Mental distress
Laraia et al., 2015²⁹29 Laraia B, Vinikoor-Imler LC, Siega-Riz AM. Food insecurity during pregnancy leads to stress, disordered eating, and greater postpartum weight among overweight women. Obesity 2015; 23(6):1303-1311.	Prospective cohort, North Carolina	688 pregnant women 28.26(SD = 6.22)	CFSM	Household food security	Mental distress
Morales et al., 2016³⁰30 Morales ME, Epstein MH, Marable DE, Oo SA, Berkowitz SA. Food insecurity and cardiovascular health in pregnant women: results from the food for families program, Chelsea, Massachusetts, 2013-2015. Prev Chronic Dis 2016; 13:E152.	Retrospective analysis, Chelsea, Massachusetts	1.295 pregnant women (aged ≥18 y)	Food access variables	FI	Cardiovascular Health
Na et al., 2016³¹31 Na M, Mehra S, Christian P, Ali H, Shaikh S, Shamim AA, Labrique AB, Klemm RD, Wu LS, West Junior KP. Maternal dietary diversity decreases with household food insecurity in rural Bangladesh: A longitudinal analysis. J Nutr 2016; 146(10):2109-2116.	Cluster-randomized, northwestern Bangladesh		HFSSM	HFI	Maternal diet
Natamba et al., 2014³²32 Natamba BK, Kilama H, Arbach A, Achan J, Griffiths JK, Young SL. Reliability and validity of an individually focused food insecurity access scale for assessing inadequate access to food among pregnant Ugandan women of mixed HIV status. Public Health Nutr 2014; 18(16):2895-2905.	Mixed-methods, cross-sectional, northern Uganda	403 pregnant women, 24.7 (SD = 5)	Food insecurity access scale	-	-
Oliveira et al., 2017³³33 Oliveira ACM, Tavares MCM, Bezerra AR. Insegurança alimentar em gestantes da rede pública de saúde de uma capital do nordeste brasileiro. Cien Saude Colet 2017; 22(2):519-526.	cross-sectional, Maceió, Brazil	428 pregnant women, 23,9 (SD = 6)	EBIA	-	Anemia
Power et al., 2017³⁴34 Power M, Uphoff E, Kelly B, Pickett KE. Food insecurity and mental health: An analysis of routine primary care data of pregnant women in the Born in Bradford cohort. J Epidemiol Community Health 2017; 71(4):324-328.	Cohort, Bradford	1593 women, 27.66 (5.6)	HFSSM.	FI	Mental health
Rasty et al., 2015³⁵35 Rasty R, Pouraram H, DorostyMotlagh A, Heshmat R. Food insecurity and some demographic and socioeconomic characteristics, fertility, and pregnancy in women with planned and unplanned pregnancy. Iran J Epidemiol 2015; 11(3):34-42.	Case-control study, Falavarjan, Isfahan	200 women with unplanned pregnancy (cases) and 200 women with planned pregnancy	HFSSM	FI and some demographic and socioeconomic characteristics	Planned and unplanned pregnancy
Yadegari et al., 2017³⁶36 Yadegari L, Dolatian M, Mahmoodi Z, Shahsavari S, Sharifi N. The relationship between socioeconomic factors and food security in pregnant women. Shiraz E Med J 2017; 18(1):e41483.	Cross sectional, Rasht (Iran).	420 pregnant women, 27.6 (Sd = 5.8)	HFSSM	-	-
Demétrio et al., 2017³⁷37 Demétrio F, Teles-Santos CAS, Santos DB. Insegurança alimentar, cuidado pré-natal e outros determinantes da anemia em mulheres grávidas da coorte Nisami, Brasil: Modelo conceitual hierárquico. Rev Bras Ginecol e Obstet 2017; 39(8):384-396.	Cross sectional, Santo Antonio de Jesus, Brazil	245 pregnant women	HFSSM-6SF	Food Insecurity, Prenatal Care	Anemia
Marano et al., 2014³⁸38 Marano D, Gama SGN, Domingues RMSM, Souza Júnior PRB. Prevalence and factors associated with nutritional deviations in women in the pre-pregnancy phase in two municipalities of the state of Rio de Janeiro, Brazil. Rev Bras Epidemiol 2014; 17(1):45-58.	Cross-sectional, Rio de Janeiro, Brazil	1,535 women in the first trimester of pregnancy, 13 - 45 years	EBIA	Socio-economic / demographic / obstetric / FI factors	Pregestational anthropometric nutritional status
Heberlein et al.,2016³⁹39 Heberlein EC, Frongillo EA, Picklesimer AH, Covington-Kolb S. Effects of Group Prenatal Care on Food Insecurity during Late Pregnancy and Early Postpartum. Matern Child Health J 2016; 20(5):1014-1024.	Prospective cohort, United States	248 pregnant women 23.6 (4.9)	HFSSM-6SF	Prenatal care in late pregnancy and early postpartum	Psychosocial outcomes among food-insecure

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[1] Collaborations

F Demetrio and M Pereira participated in the article’s conception, systematic literature review, analysis, and writing and final revision. DB Santos and CAS Teles participated in the critical revision and approval of the final version.