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A obesidade se caracteriza pelo acúmulo de tecido adiposo no organismo e afeta principalmente as mulheres atingindo mais de 20% das brasileiras. Atualmente é um dos principais problemas de saúde pública, sendo considerada como “epidemia do século 21” pela Organização Mundial da Saúde (OMS). Segundo dados do Ministério da Saúde houve um aumento no número de pessoas obesas de 67,8% entre 2006 e 2018.
É uma doença multifatorial que abrange fatores genéticos, metabólicos, sociais, econômicos, comportamentais, culturais e muito associado a e aumento de ingesta calórica e inatividade física.
Definimos a obesidade de acordo com o IMC (índice de massa corporal) calculado pela divisão do valor do peso pré-gestacional ( em kg ) pelo quadrado da estatura ( metros).
Um IMC maior ou igual a 30 kg/m² significa obesidade e acima de 40 kg/m² obesidade mórbida. A partir do diagnóstico é necessário que a paciente seja encaminhada para o pré-natal de alto risco pois a obesidade é um fator de risco independente para complicações maternas e perinatais .
Gestantes com IMC acima de 35 kg/m² tem 3x mais risco de óbito fetal quando comparadas a gestantes com peso normal e também tem 5x mais risco para pré-eclâmpsia.
As principais complicações da obesidade na gravidez são:
- Diabetes gestacional,
- Síndromes hipertensivas
- Crescimento intrauterino restrito,
- Infecções urinárias
- Complicações anestésicas,
- Infecções pós-parto
- Malformações fetais
- Macrossomia fetal
O tratamento da obesidade, assim como as suas causas deve ser avaliado de maneira multifatorial, abordando tanto as questões genéticas e metabólicas como as questões emocionais, culturais e principalmente as comportamentais.
É muito importante seguir um plano alimentar saudável, de acordo com as orientações recebidas pelo nutricionista ao longo do ciclo gravídico pois a gestante obesa precisa de um menor ganho ponderal, em torno de 5 a 9 kg.
O ideal é que a gestante seja encaminhada ainda no primeiro trimestre da gestação para atendimento e acompanhamento com o nutricionista para realizar o monitoramento do seu ganho ponderal por meio de intervenções nutricionais precoces e eficazes, com orientação individualizada, contribuindo, dessa forma, para o resultado obstétrico mais favorável, reduzindo a morbidade materna e fetal.
A mulher deve manter hábitos alimentares saudáveis, seguir uma ingestão calórica apropriada, evitando alimentos ricos em gordura e açúcares.
A atividade física, desde que não haja contraindicações, é benéfica e deve ser orientada por um profissional especializado pois a atividade deve ser ajustada à capacidade física da gestante, assim como também será importante uma avaliação cardiológica prévia para melhor programação da atividade.
O acompanhamento pré-natal seguirá os protocolos de alto risco, com consultas frequentes, realização de exames laboratoriais, suplementação vitamínica quando necessário e exames ecográficos. Os exames de imagem necessitam de uma atenção especial pois existe um maior risco de malformações e muitas vezes a espessura do panículo adiposo pode dificultar a adequada avaliação fetal.
O parto segue as indicações obstétricas e pode-se ter alguma dificuldade de avaliação da monitorização fetal e das contrações uterinas. É possível complicações no procedimento anestésico (para analgesia ou cesariana) por dificuldade na punção lombar e em caso de cesariana maior risco para infecções. Durante o puerpério é indicado movimentar-se o mais precoce possível e o uso de medicamentos para prevenção de trombose está indicado.
Muito além de questões estéticas ou de padrões de beleza precisamos entender e avaliar a obesidade como uma doença crônica que necessita de um acompanhamento respeitoso, sem preconceitos ou julgamentos, visando a redução de riscos e buscando a saúde materna e fetal.
Fontes: Portal Fiocruz.br/Obstetricia – Marcelo Zugaib
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text_shadow_blur=”0″ text_shadow_color=”” margin_top_medium=”” margin_right_medium=”” margin_bottom_medium=”” margin_left_medium=”” margin_top_small=”” margin_right_small=”” margin_bottom_small=”” margin_left_small=”” margin_top=”” margin_right=”” margin_bottom=”2px” margin_left=”” margin_top_mobile=”” margin_bottom_mobile=”” text_color=”#202020″ animated_text_color=”” highlight_color=”” style_type=”default” sep_color=”” link_color=”” link_hover_color=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=””]Dra. Fernanda Torino[/fusion_title][fusion_title title_type=”text” rotation_effect=”bounceIn” display_time=”1200″ highlight_effect=”circle” loop_animation=”off” highlight_width=”9″ highlight_top_margin=”0″ before_text=”” rotation_text=”” highlight_text=”” after_text=”” title_link=”off” link_url=”” link_target=”_self” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” sticky_display=”normal,sticky” class=”” id=”” content_align_medium=”” content_align_small=”” content_align=”left” size=”6″ font_size=”” animated_font_size=”” fusion_font_family_title_font=”Poppins” fusion_font_variant_title_font=”700″ line_height=”” letter_spacing=”” text_shadow=”no” text_shadow_vertical=”” text_shadow_horizontal=”” text_shadow_blur=”0″ text_shadow_color=”” margin_top_medium=”” margin_right_medium=”” margin_bottom_medium=”” margin_left_medium=”” margin_top_small=”” margin_right_small=”” margin_bottom_small=”” margin_left_small=”” margin_top=”” margin_right=”” margin_bottom=”” margin_left=”” margin_top_mobile=”” margin_bottom_mobile=”” text_color=”#202020″ animated_text_color=”” highlight_color=”” style_type=”default” sep_color=”” link_color=”” link_hover_color=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=””]Ginecologista e Obstetra, CRM: 19772, RQE: 11733[/fusion_title][fusion_text columns=”” column_min_width=”” column_spacing=”” rule_style=”default” rule_size=”” rule_color=”” content_alignment_medium=”” content_alignment_small=”” content_alignment=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” sticky_display=”normal,sticky” class=”” id=”” margin_top=”” margin_right=”” margin_bottom=”10px” margin_left=”” font_size=”” fusion_font_family_text_font=”” fusion_font_variant_text_font=”” line_height=”” letter_spacing=”” text_color=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=””]Ginecologia e Obstetrícia | Pré-Natal de Alto Risco | Gestação de Alto Risco[/fusion_text][fusion_text columns=”” column_min_width=”” column_spacing=”” rule_style=”default” rule_size=”” rule_color=”” content_alignment_medium=”” content_alignment_small=”” content_alignment=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” sticky_display=”normal,sticky” class=”” id=”” margin_top=”0px” margin_right=”” margin_bottom=”10px” margin_left=”” font_size=”15px” fusion_font_family_text_font=”Poppins” fusion_font_variant_text_font=”400italic” line_height=”” letter_spacing=”” text_color=”#7e858e” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=””]“Conhecemos as várias funções exercidas pelas mulheres, por isso é necessário que o cuidado englobe todos os aspectos da vida . Sendo múltipla não pode ser tratada como parte.”[/fusion_text][fusion_button link=”https://grupoelasbrasilia.com.br/fernandatorino/” text_transform=”” title=”” target=”_self” link_attributes=”” alignment_medium=”” alignment_small=”” alignment=”” modal=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” sticky_display=”normal,sticky” class=”” id=”” color=”default” button_gradient_top_color=”” button_gradient_bottom_color=”” button_gradient_top_color_hover=”” button_gradient_bottom_color_hover=”” accent_color=”” accent_hover_color=”” type=”” bevel_color=”” border_width=”” border_radius=”” border_color=”” border_hover_color=”” size=”small” stretch=”default” margin_top=”” margin_right=”” margin_bottom=”” margin_left=”” icon=”fusion-prefix-fa-message-medical” icon_position=”left” icon_divider=”no” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=””]CONHEÇA A MÉDICA[/fusion_button][/fusion_builder_column_inner][/fusion_builder_row_inner][/fusion_builder_column][fusion_builder_column type=”1_6″ layout=”1_6″ align_self=”auto” content_layout=”column” align_content=”flex-start” valign_content=”flex-start” content_wrap=”wrap” spacing=”” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” sticky_display=”normal,sticky” class=”” id=”” order_medium=”0″ order_small=”0″ hover_type=”none” border_color=”” border_style=”solid” box_shadow=”no” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” background_type=”single” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” background_blend_mode=”none” filter_type=”regular” filter_hue=”0″ 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padding_top=”6%” admin_label=”Call to Action Agendamento” admin_toggled=”yes” background_image=”https://ml1ca8kph5lh.i.optimole.com/f8pwKbQ-zroGwOxF/w:auto/h:auto/q:auto/https://grupoelasbrasilia.com.br/wp-content/uploads/2021/05/cta-agende-sua-consulta.jpg” padding_bottom=”5%” padding_left=”0px” padding_right=”0px” background_color=”rgba(0,0,0,0.6)”][fusion_builder_row][fusion_builder_column type=”1_1″ layout=”1_2″ align_self=”center” content_layout=”column” align_content=”flex-start” content_wrap=”wrap” spacing=”” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” sticky_display=”normal,sticky” class=”” id=”” order_medium=”0″ order_small=”0″ hover_type=”none” border_color=”” border_style=”solid” box_shadow=”no” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” background_type=”single” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” background_blend_mode=”none” animation_type=”fade” animation_direction=”right” animation_speed=”1.0″ animation_offset=”” filter_type=”regular” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″ padding_right=”” last=”true” border_position=”all” padding_right_small=”0px” first=”true”][fusion_title title_type=”text” rotation_effect=”bounceIn” display_time=”1200″ highlight_effect=”circle” loop_animation=”off” highlight_width=”9″ highlight_top_margin=”0″ before_text=”” rotation_text=”” highlight_text=”” after_text=”” content_align_medium=”” content_align_small=”center” content_align=”center” size=”2″ font_size=”” animated_font_size=”” line_height=”” letter_spacing=”” dimensions_medium=”” dimensions_small=”” text_color=”#dbc5a6″ animated_text_color=”” highlight_color=”” style_type=”default” sep_color=”” animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” sticky_display=”normal,sticky” class=”” id=”” fusion_font_variant_title_font=”700″ fusion_font_family_title_font=”Open Sans” margin_bottom=”30px”]Agende sua consulta[/fusion_title][fusion_button link=”https://grupoelasbrasilia.com.br/contato/” text_transform=”” title=”” target=”_self” link_attributes=”” alignment_medium=”” alignment_small=”” alignment=”center” modal=”” color=”default” button_gradient_top_color=”” button_gradient_bottom_color=”” button_gradient_top_color_hover=”” button_gradient_bottom_color_hover=”” accent_color=”” 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