title: Nutritional assessment of pregnant adolescents: comparison of two popular classification systems.
abstract: The objective of this study was to assess the degree of concordance between two popular classification systems [the Centers for Disease Control and Prevention (CDC)-2000 and the Institute of Medicine (IOM)-2009] used to categorise the nutritional status of pregnant adolescents. This cross-sectional study involved 327 pregnant adolescents (10-19 years) booking for antenatal care at a single public maternity in São Paulo, Brazil. Participants were classified into one of four categories, by both systems according to their pre-pregnancy body mass index and age. The CDC-2000 system classified significantly fewer pregnant adolescents as underweight (3.7% vs. 12.5%, P < 0.0001) and significantly more adolescents as normal-weight (86.8% vs. 75.6%, P = 0.0003) than the IOM-2009 system. The distribution of the adolescents in the two systems differed significantly. The global rate of discordance was 13.5%. The overall concordance between the two systems was marginally good (K = 0.63), being moderate for younger (<16 years) adolescents (K = 0.52). Approximately one in every seven pregnant adolescent would be classified in a non-corresponding category if the IOM-2009 classification was used instead of the CDC-2000 classification. The IOM-2009 nutritional classification, which does not take into account age and gender, tends to overestimate the proportion of underweight adolescents, especially in the younger-age group. The use of this classification system can lead to recommendations of higher gestational weight gain in a substantial proportion of pregnant adolescents, which could predispose to post-partum weight retention and future obesity.
authors.affiliation: Department of Obstetrics, São Paulo Federal University, São Paulo, Brazil.
authors.forename: Janaina de Fátima Ávila
authors.initials: Jde F
authors.lastname: Amaral
authors.affiliation: Department of Obstetrics, São Paulo Federal University, São Paulo, Brazil.
authors.forename: Guilherme Miranda
authors.initials: GM
authors.lastname: Vasconcelos
authors.affiliation: Department of Obstetrics, São Paulo Federal University, São Paulo, Brazil.
authors.forename: Maria Regina
authors.initials: MR
authors.lastname: Torloni
authors.affiliation: Department of Pediatrics, São Paulo Federal University, São Paulo, Brazil.
authors.forename: Mauro
authors.initials: M
authors.lastname: Fisberg
authors.affiliation: Department of Pediatrics, São Paulo Federal University, São Paulo, Brazil.
authors.forename: Isa de Pádua Cintra
authors.initials: Ide P
authors.lastname: Sampaio
authors.affiliation: Department of Obstetrics, São Paulo Federal University, São Paulo, Brazil.
authors.forename: Cristina Aparecida Falbo
authors.initials: CA
authors.lastname: Guazzelli
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D015992:Body Mass Index; D001835:Body Weight / Q000502:physiology*; D001938:Brazil; D002487:Centers for Disease Control and Prevention, U.S.; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015969:National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division; D015596:Nutrition Assessment; D009752:Nutritional Status / Q000502:physiology; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000502:physiology*; D039401:Prenatal Nutritional Physiological Phenomena / Q000502:physiology*; D014481:United States; D055815:Young Adult