Manual de enfermagem para o cuidado integral a gestantes com sobrepeso e obesidade na atenção primária à saúde

Abstract

Introduction: Overweight and obesity are complex multifactorial chronic conditions that have shown a significant increase worldwide, particularly among women of reproductive age, representing an important public health challenge. During pregnancy, these conditions are associated with a higher risk of maternal and neonatal complications, such as gestational diabetes, hypertension, and preeclampsia. In this context, Primary Health Care plays a fundamental role in prenatal follow-up, with nursing consultation standing out as an important strategy for health promotion and prevention of complications, particularly in Amazonian contexts marked by social and territorial vulnerabilities. Objective: To develop a nursing manual for comprehensive care of pregnant women with overweight and obesity in Primary Health Care, aiming to promote maternal and fetal health, prevent complications related to excessive weight, and improve perinatal outcomes. Method: This is a methodological study developed in three stages. The first stage consisted of the analysis of secondary data from the Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey 2023, focusing on pregnant women in the Northern region of Brazil, aiming to estimate prevalence and identify factors associated with overweight and obesity. The second stage involved an Integrative Literature Review to identify scientific evidence regarding comprehensive nursing care and best practices in nursing consultations for pregnant women with excessive weight. Textual data from the selected studies were organized into a textual corpus and analyzed through lexical analysis using the Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires software, applying the Descending Hierarchical Classification technique to identify thematic classes related to nursing care practices. The third stage consisted of the development of the initial version of a practical nursing manual, structured as a digital technical-technological product, based on scientific evidence and adapted to the reality of Primary Health Care in the interior of the Amazon. Results: The analysis of data from the Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey 2023 showed a high prevalence of overweight and obesity among pregnant women in the Northern region of Brazil, associated with sociodemographic and behavioral factors and the presence of comorbidities such as hypertension and diabetes mellitus. The Integrative Literature Review allowed the identification and systematization of scientific evidence reinforcing the central role of nursing in comprehensive care for pregnant women with excessive weight, highlighting practices related to clinical and anthropometric assessment, monitoring of gestational weight gain, health education, strengthening of the therapeutic relationship, and multiprofessional care. Based on these findings, an initial version of a practical nursing manual was developed, structured in sections addressing conceptual foundations of overweight and obesity in pregnancy, principles of comprehensive care, practical guidelines for prenatal nursing consultations, health promotion strategies and empowerment of pregnant women, as well as professional support tools including flowcharts, summary tables, checklists, scales, and proposals for Standard Operating Procedures to facilitate clinical decision-making in Primary Health Care. Considerations: The manual has the potential to support nurses’ clinical practice, contribute to the standardization of care, strengthen professional autonomy, and improve prenatal care for pregnant women with overweight and obesity in Primary Health Care.