Autoras: Ana Cristina Freitas de Vilhena Abrão, Maria José Guardia Mattar e Kelly Pereira Coca
A recomendação da amamentação durante a gravidez tem sido bastante controversa visto a frequente preocupação dos profissionais com as consequências desta prática. O aleitamento materno é recomendado até seis meses exclusivo e continuado até dois anos ou mais (OMS).² Os benefícios de uma amamentação exclusiva e prolongada são consistentes e bem estabelecidos.² Apesar das recomendações, as mulheres vêm enfrentando um dilema na continuidade da amamentação diante de uma nova gravidez, que apesar do desejo de continuar a amamentação do filho mais velho, o desmame é muito comum nesta situação, seja por insegurança materna, pressão social decorrente da cultura do país e até mesmo por recomendação médica.³
A prevalência do aleitamento materno entre gestantes é variável. Estudos mostram taxas entre 5% e 61% em diferentes continentes, sendo mais altas em países com culturas favoráveis ao aleitamento materno 4. Acredita-se que estes valores possam estar subestimados pelo medo do julgamento que as gestantes vivenciam quando amamentam.
Uma revisão sistemática publicada recentemente investigou todos os estudos existentes a respeito da temática, entre 1990 a 2015, e analisou 19 estudos dos 3.278 artigos identificados, representando 6.315 participantes (2073 casos e 4.242 controles) no total.4 Dentre os desfechos avaliados, têm-se: abortamento espontâneo, parto prematuro, condição nutricional materna, quantidade e composição do leite materno, continuidade do aleitamento materno durante a gestação, peso de nascimento e crescimento da criança.
No que se refere ao risco de abortamento, os sete estudos encontrados mostraram taxas similares entre gestantes (0% – 15,6%; n=816) e não gestantes (0% – 19,6%; n=1.706) que estavam amamentando. Em relação ao parto prematuro, as taxas variaram entre 2,2% e 7,7% em gestantes que estavam amamentando e entre 0% e 10,3% daquelas que não estavam em aleitamento materno4. Apenas um estudo encontrou o risco de abortamento espontâneo, no entanto, limitações metodológicas importantes foram identificadas, tais como: a gestante foi recrutada no final da gestação e os dados obstétricos eram limitados, o que pode ser a razão da discrepância entre esse e os dos demais resultados.5
Quanto à condição nutricional materna, a revisão sistemática identificou deficiência entre gestantes que amamentam, assim como foram observados uma diminuição da hemoglobina e menor ganho de peso materno. As gestantes que amamentaram vivenciaram uma redução da produção láctea nos seis estudos identificados, menor quantidade de gordura e lactose em três destes estudos. Os resultados indicaram ainda que o leite maduro se transforma em colostro no final da gravidez, apesar da falta de consenso acerca dos componentes afetados. O tempo de amamentação observado foi variável e menor com o avançar da gestação.5
Em relação ao peso de nascimento da criança, observou-se porcentagem maior de recém-nascidos com baixo peso ao nascer e pequenos para a idade gestacional, no entanto, sem diferença significativa. Quanto ao crescimento, os dados são ainda inconsistentes pelo reduzido número amostral e limitações metodológicas dos estudos encontrados. 5
De acordo com os estudos existentes conclui-se que a amamentação durante a gestação é possível e pode ser apoiada para as mulheres de risco habitual. O profissional não deve aconselhar o desmame e sim monitorar a situação de saúde desta gestante para analisar situações especiais, para identificar possíveis riscos e benefícios associados.
Referencias utilizadas:
- WHO, UNICEF. Global strategy for infant and young child feeding. Geneva: World Health Organization, 2003.
- Victora CG, Bahl R, Barros AJD, França GVA, Horton S, Krasevec et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387: 475–90.
- Dettwyler KA. When to wean biological versus cultural perspectives. Clin Obstet Gynecol. 2004;47(3):712-23.
- López-Fernández G, Barrios M, Goberna-Tricas J, Gómez-Benito J. Breastfeeding during pregnancy: a systematic review. Woman and birth. 2017;30(6):e292-e300.
- Albadran MM. Effect of breastfeeding during pregnancy on the occurrence of miscarriage and preterm labour. Iraqui JMS. 2013;11(3):285-9.
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