Nutrição e Gravidez Multifetal

Abstrair

Em grande parte por causa da reprodução assistida, a taxa de gravidez

multifetal está aumentando rapidamente nos Estados Unidos. Nesse sentido,

os nutricionistas estão sendo cada vez mais requisitados para prestar serviços

de nutrição para essas gestações de alto risco. Este artigo apresenta uma

visão geral da incidência e dos riscos associados à gravidez multifetal e revisa

estudos que contribuem para o nosso conhecimento sobre nutrição e gravidez

multifetal. Sugerem-se diretrizes práticas para a promoção de resultados

saudáveis com base nos melhores dados científicos disponíveis. Diretrizes

para ganho de peso para gravidez de gêmeos e trigêmeos, ingestão dietética e

uso de suplementos estão incluídos. As diretrizes de prática sugeridas para

gravidez multifetal incluem uma taxa positiva de ganho de peso no início da

gravidez, o uso do status de peso pré-gestacional para determinar as metas de

ganho de peso total em gravidez gemelar, uma meta de ganho de peso de 50

lb para gravidez de trigêmeos e maior número mínimo de porções de alimentos

de vários dos grupos da Pirâmide do Guia Alimentar. A necessidade de

informações adicionais sobre os efeitos do estado nutricional no curso e

desfecho da gestação multifetal é crítica Evidências preliminares dos benefícios

dos serviços de nutrição sugerem que tanto a incorporação de serviços

dietéticos em programas assistenciais quanto pesquisas adicionais sobre

nutrição e gestação multifetal são necessárias. J Am Dieta Assoc. 2000;

100:343-348.
Trechos de seção

Tendências e Riscos

A tendência de aumento substancial das taxas de gravidez multifetal nos

Estados Unidos começou no início da década de 1980. Os nascimentos

gemelares, que constituíram 94% dos 100.750 partos multifetais em 1996,

representaram 1 em cada 56 nascimentos em 1980 e 1 em 38 nascimentos em

1996 (1). No início da década de 1970, os nascimentos de trigêmeos ocorriam

à taxa de 1 em 3.500 nascimentos, mas em 1996, a razão era de 1 em 785

(15). Somente entre 1995 e 1996, os nascimentos de quadrigêmeos

aumentaram 53% (de 1 em 10.684 para 1 em 6.949 nascimentos), e

Estudos de Nutrição: Ganho de Peso

Dos fatores nutricionais que podem influenciar o curso e o desfecho da

gestação multifetal, o ganho de peso foi o que mais foi estudado. Assim como

na gestação única, o ganho de peso está positiva e linearmente relacionado ao

peso ao nascer em gestação gemelar (17), (24). Essa relação é mais forte para

mulheres que entram na gestação com baixo peso ou peso normal (17), (34).

Ganhos de peso gestacionais associados ao parto de gêmeos de tamanho

saudável (definidos pelos estudos como bebês com peso ao nascer em

excesso

Estudos de Nutrição: Ingestão Dietética

Garantir uma "nutrição adequada" é amplamente reconhecido na literatura

obstétrica como um componente-chave do cuidado para mulheres com

gravidez multifetal (16), (42), (43), (44). Embora o tema da dieta e gravidez

multifetal permaneça pouco estudado, uma série de relatos estão disponíveis

que lançam alguma luz sobre as necessidades de energia e nutrientes. Os

principais resultados indicam uma maior necessidade de energia e vários

nutrientes entre as mulheres que têm gêmeos. Evidência de que a necessidade

de energia é aumentada em relação à

Nutrition Intervention and the Outcome of Twin Pregnancy

Two studies indicate that outcomes of twin pregnancy improve if women are

served by high-risk clinics that provide nutrition education, counseling, and

other preventive services (8), (9). The strongest evidence that nutrition

intervention positively affects multifetal gestation, however, comes from a study

at the Montreal Diet Dispensary (MDD) (10). Outcomes of 354 twin pregnancies

served by MDD dietitians were compared with those of 686 unserved and

lower-risk women in Montreal, Canada, based

Applications: Best Practice Advice

■ Based on available scientific evidence, it appears reasonable to conclude that

women with multifetal pregnancy have an increased need for weight gain,

energy, essential fatty acids, iron, calcium, and other nutrients compared with

women with singleton pregnancy (Fig. 2).

■ Newer data on weight gain support the Institute of Medicine's

recommendation for a total weight gain in twin pregnancy of 35 to 45 lb (35). It

now appears that underweight women should gain at the high end of this range

and

Cited by (34)

Elemental content of the placenta: A comparison between two high-risk

obstetrical populations, adult women carrying multiples and adolescents

carrying singletons

2017, Environmental Research

Citation Excerpt :

Insufficient nutrient and/or oxygen exchange, for example, may lead to

miscarriage, preterm delivery, intrauterine growth restriction, and other adverse

birth outcomes (Caserta et al., 2013; Eisenmann and Miller, 1996; Redline,

2008; Regnault et al., 2002; Salafia et al., 2016). Risks of adverse pregnancy

and birth outcomes are further exacerbated in certain populations of pregnant

women such as adult women carrying multiples and adolescents carrying

singletons (Brown and Carlson, 2000). With levels of industrialization rising

globally, inorganic elements (e.g., metals), including rare earth elements

(REEs), are becoming increasingly present in soil, freshwater, and oceans

(Pagano et al., 2015b; Zaichick et al., 2011).

The placenta is responsible for the exchange of nutrients and for preventing

harmful compounds from entering the fetal circulation. With increasing

industrialization, exposures to commercial and toxic metals become a concern

for both pregnant women and those planning a pregnancy. The understanding

of transport mechanisms and pharmacokinetics for most inorganic elements is

incomplete and limited to normal term deliveries.

To obtain novel data on 46 inorganic elements in placentae from two high-risk

obstetric populations, women carrying multiples and adolescents carrying

singletons, evaluating differences, if present, and identifying predictors of

placental content.

Placental tissue was collected from adolescents carrying singletons and adults

carrying multiples. Elemental content was analyzed using inductively coupled

plasma-mass spectrometry (ICP-MS). Multivariate regression and factor

analyses were used.

With the exception of Au and Pt, almost all placentae contained quantifiable

concentrations of each element analyzed. All placentae contained the essential

elements Ca, Fe, Mg, Se and Zn, which clustered together onto the same

factor. Most elements were higher in placentae from women carrying multiples.

Differences in placental content disappeared after adjusting for maternal age.

Rare earth elements (REEs) clustered together and remained higher in the

multiples even after adjusting for maternal age.

Human placentae contain a wide range of elements, including REEs. Ranges

differed considerably between cohorts. Elements with similar chemical

properties, like REEs or nutritionally essential elements, clustered together.

Maternal age, and therefore longer environmental exposure, was significantly

associated with elevated element concentrations in the placenta. Placental

concentrations of several metals that are known to be nutritionally essential

(e.g., Fe, Ca, Mg, and Zn) did not differ significantly between cohorts,

suggesting tight regulation, whereas concentrations of environmental

contaminants differed significantly between groups, even after adjusting for

maternal age.

Twin weight discordance and maternal weight gain in twin pregnancies

2007, International Journal of Gynecology and Obstetrics

Citation Excerpt :

These two groups did not show significant differences for any other factors. The

patterns of the mean maternal weight change in twin pregnancies agreed with

previous reports, although the actual gestational intervals were slightly different

from this study [13,14,18]. The present study has found that the weight

discordance of twins at an early stage remained unchanged as long as maternal

weight constantly increased throughout pregnancy.

To evaluate the association between twin weight discordance and maternal

weight change during the gestational period.

One hundred forty-seven twin pregnancies (Group A: < 25%, Group B: ≥ 25%

birth weight discordance) were analyzed using Student's t-test, χ2-test, and two-

way ANOVA at three gestational intervals: before 18 weeks, 18 to 28 weeks,

and 28 weeks to birth.

There was no statistically significant difference between the two groups

involving maternal age, parity, duration of pregnancy, height, pregravid weight,

and conception method. Group A showed a pattern of constantly increasing

maternal weight without a significant change in the twin weight discordance

throughout gestation. However, Group B showed a fluctuation in maternal BMI

with remarkably elevated twin weight discordance at 28 weeks to birth.

The results suggest that in twin pregnancies constant maternal weight gain

throughout gestation is important for maintaining a twin weight discordance of

less than 25%.

Nutritional recommendations for multiple pregnancy

2005, Journal of the American Dietetic Association

Citation Excerpt :
Low status of essential fatty acids in women with multifetal pregnancy may

impair infant neurological and visual development (13,14). Good sources of

essential fatty acids include sunflower, safflower, corn, and soybean oil, as well

as egg yolk, meat, fatty fish, canola and soybean oil, walnuts, and spinach

(5,15). One study in singleton pregnancies found that fish oil supplementation

increased pregnancy duration by an average of 4 days and slightly increased

birthweight (16).

Prenatal nutrition and birth outcomes

2004, JOGNN - Journal of Obstetric, Gynecologic, and Neonatal Nursing

Citation Excerpt :

Adequate dietary intake and weight gain during pregnancy are essential to

ensure optimal birth outcomes in these pregnancies at high risk. Brown and

Carlson (2000) offered evidence-based practice guidelines for weight gain,

dietary intake, and supplement use in multifetal pregnancies. Mothers carrying

twins should gain between 35 and 45 pounds.

The complex relationship between maternal nutritional and birth outcomes

emphasizes the need for consistent and thorough assessments of women's diet

throughout pregnancy and individualized nutritional education to promote

positive birth outcomes. The purpose of this article is to examine the influence

of prenatal nutrition on birth outcomes, describe research on the effects of

macro‐ and micronutrients on birth outcomes, and discuss strategies for

monitoring diet and implementing nutrition education during pregnancy.

Twin studies advance the understanding of gene-environment interplay in

human nutrigenomics

2014, Nutrition Research Reviews

Influence of weight gain, according to Institute of Medicine 2009

recommendation, on spontaneous preterm delivery in twin pregnancies

2018, BMC Pregnancy and Childbirth

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