Fatores nutricionais e psicológicos associados com a ocorrência de picamalácia em gestantes

Abstract

sonAly Petronilho heidelmAnn 3 CláudiA sAunders 4 Resumo OBJETIVO: Avaliar fatores nutricionais e psicológicos associados com a ocorrência da prática da picamalácia em gestantes atendidas em maternidade pública do Rio de Janeiro, Brasil. MÉTODOS: Estudo descritivo, de caráter exploratório, realizado com 13 gestantes (idades entre 16 e 40 anos) com diagnóstico de picamalácia na gestação atual identificada em entrevista padronizada na consulta com nutricionista que abordava questões sobre ocorrência e frequência do transtorno, além dos tipos de substâncias ingeridas. Após assinarem o Termo de Consentimento Livre e Esclarecido (TCLE), todas as gestantes passaram por avaliação nutricional e, posteriormente, sete foram submetidas à avaliação psicológica com instrumentos padronizados para medida de ansiedade e estresse, além da avaliação de estratégias de enfrentamento (coping) diante de estressores. RESULTADOS: As práticas de picamalácia mais referidas foram pagofagia (30,8%) e fruta com sal (30,8%). Observou-se ocorrência de algum grau de estresse e ansiedade em todas as gestantes com picamalácia, assim como alguma comorbidade (69,2%) e sintomatologia digestiva (84,6%). As estratégias de coping mais prevalentes foram "focada em práticas religiosas/pensamento fantasioso" e "busca de suporte social", ambas com 42%. CONCLUSÃO: Considerando que a picamalácia pode associar-se com maior risco perinatal, é fundamental que essa prática seja investigada durante o atendimento pré-natal e que ocorra a adoção de práticas preventivas obstétricas, psicológicas e nutricionais para reduzir complicações para a mãe e o concepto. Abstract PURPOSE:To evaluate the nutritional and psychological factors associated with the occurrence of the practice of pica in pregnant women attending a public hospital in Rio de Janeiro, Brazil. METHODS: The study was based on a descriptive design with exploratory features, and conducted on 13 adult and adolescent pregnant women aged 16 to 40 years with a diagnosis of pica in the current pregnancy. Pica was diagnosed by a nutritionist in a standardized interview situation, when questions about the occurrence and frequency of pica, and types of substance ingestion were investigated. After signing the Informed Consent Form (ICF), all participants were evaluated by a nutritionist and seven of them were submitted to psychological assessment with standardized instruments to evaluate stress and anxiety, and to assess coping strategies. RESULTS: The type of pica most frequently reported was pagophagia (30.8%) and the consumption of fruit with salt (30.8%). The most prevalent coping strategies were "religious practice-focused" and "seeking social support", both presented by 42% of the pregnant women. We observed the occurrence of some degree of stress and anxiety in all pregnant women, as well as comorbidities (69.2%) and gastrointestinal symptoms (84.6%). CONCLUSION: Considering that pica may be associated with increased perinatal risk, it is very important to investigate this disorder during prenatal care, and ...

Pica in the Pregnancy and Related Psychological Aspects

“…As previous study suggested (Ayeta et al, 2015), it was observed a prevalence of two types of coping among pregnants with pica: "coping based on the searching for social support" and "coping based on the religious practice or imaginative thoughts". Regarding to the "coping based on the searching for social support" we observed that family support was very important for most of those women, either because they share the same food preferences, or because family members prevent the fulfi llment of uncontrolled desire for substances, sometimes toxic (detergents, for example) or exotic (mango with salt, lemon with salt, etc.).…”

“…Pregnant women who practice pica show signifi cant signs of stress at some level (Ayeta et al, 2015;Woods, Melville, Guo, Fan, & Gavin, 2010), and many of them develop signs of anxiety during pregnancy (Vythilingum, 2008). Psychological variables, such as anxiety and depression, can affect the mother during prenatal period, contributing to negative obstetric outcomes, such as prematurity, low birth weight and child development problems (Ding et al, 2014;Van Batenburg-Eddes et al, 2013).…”

“…It results on a greater chance of fetal complications (neonatal hypoglycemia, respiratory disorders and even fetal death intrauterine; SBD, 2015; Brazilian Society of Endocrinology and Metabolism, 2015). or more non-nutritive or nonfood substances on a persistent basis over a period of at least one month, and it is severe enough to demand clinical attention (American Psychiatric Association, 2013). This disorder has been little studied, especially in regard to psychological aspects (Ayeta et al, 2015;Saunders et al, 2009, p. 441). According to the DSM-5, a person who be diagnosed with pica must show: (a) Persistent eating of non-nutritive substances for at least one month, (b) The eating of non-nutritive substances is inappropriate to the individual developmental level; (c) The eating behavior is not a part of a culturally or socially normative practice; (d) If the eating behavior occurs in the context of another mental disorder (e.g., intellectual disability, autism spectrum disorder, schizophrenia) or medical condition (including pregnancy), it is severe suffi cient to demand additional clinical attention.…”

“…Recent study discusses the relationship between pregnancy with GDM and pica in Brazilian pregnant women (Ayeta et al, 2015). Few studies have investigated associations between pregnancy with GDM and pica practice.…”

“…Few studies have investigated associations between pregnancy with GDM and pica practice. Some of them confi rms that the diabetes in pregnancy increases a high chance of developing this disorder (Ayeta et al, 2015;Ezzeddin, Zavoshy, Noroozi, Jahanihashemi, & Riseh, 2015;Gangopadhyay, Karoshi, & Keith, 2011). Nevertheless, only one of these studies discussed psychological aspects related to pica in Brazilian pregnant women (Ayeta et al, 2015).…”