Original article Nutr. wedge. diets. hosp.

2017; 37(3):53-57
DOI: 10.12873/373pinzon

Nutritional risk in hospitalized pregnant women.

Nutritional risk in hospitalized pregnant women

Pinzón Espitia, Olga Lucia1,2

1 National University of Colombia.
2 University Hospital Mayor Méderi.

Received: January 31, 2017. Accepted: July 28, 2017.

SUMMARY olpinzone@unal.edu.co

Objective: Evaluate the nutritional risk of pregnant

women hospitalized in a high-complexity hospital,
using the nutritional screening tool in pregnant
women OLNUT.
Material and methods: Observational research,
cross-sectional cohort of 258 hospitalized pregnant
women. Nutritional risk was evaluated upon
admission to hospitalization using a screening tool
that inquired about four key aspects: implications of
the clinical diagnosis on nutritional status, changes in
diet, classification of pregestational and gestational
BMI, which allowed the population to be classified
according to nutritional risk and referred to a
nutritional care plan.
Results: High nutritional risk was detected in 194
patients (75.2%), using the screening tool. It is
observed that 117 patients (45.3%) of the
population were hospitalized with clinical diagnoses
that impacted the nutritional status, with it being
relevant to highlight that 158 (61.2%) pregnant
women started pregnancy with a normal BMI, and
upon hospital admission, 121 (46.9%) of the
pregnant women still maintained a BMI within
normal parameters.
Conclusions: The OLNUT nutritional screening tool
for pregnant women allows for a simple way to
establish the nutritional risk of women during
pregnancy upon admission to the hospital.

Correspondence: Olga
Lucia Pinzón Espitia
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37(3):53-57 clín. diet. hosp. 2017; 1
KEYWORDS
Pregnant women, nutritional status, malnutrition,
nutritional assessment.

ABSTRACT
Objective: To evaluate the nutritional risk of
hospitalized pregnant women in a hospital of high
complexity, using the nutritional screening tool in
OLNUT pregnant women.
Material and methods: Observational, transverse
cohort study of 258 hospitalized pregnant women.
Nutritional risk was assessed at admission to the
hospital by means of a screening tool, which
investigated four key aspects: implications of clinical
diagnosis in nutritional status, changes in diet,
classification of pregestational and gestational BMI,
which allowed the classification of the population
Depending on nutritional risk and refer to a
nutritional care plan.
Results: High nutritional risk was detected in 194
patients (75.2%), with the screening tool. A total of
117 patients (45.3%) of the population were
hospitalized with clinical diagnoses that impacted
the nutritional status, and it was important to note
that 158 (61.2%) pregnant women started the
pregnancy with a normal BMI, and 121 (46.9%) had
hospital admission. Of the pregnant women still
maintained the BMI within parameters of normality.
Conclusions: The nutritional screening tool in
OLNUT pregnant women allows, in a simple way, to
establish the nutritional risk of pregnant women on
admission to the hospital.

KEYWORDS
Pregnant Women, nutritional status, malnutrition,
nutrition assessment.

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ABBREVIATIONS In 2016, 258 nutritional risk screening forms were analyzed

ICD-10: International Classification of Diseases, tenth
version.
IMC: Body Mass Index. LMP: Last
Menstrual Period.
WHO: World Health Organization.
OLNUT: Nutritional screening tool in pregnant women.
INTRODUCTION
Nutritional status during pregnancy plays a fundamental role,
WHO emphasizes the influence of this on the health outcomes
of the fetus, the infant, and the mother, and therefore it is of
utmost importance to manage nutritional care since an
affectation of the same can cause complications in pregnancy,
putting the mother and child at risk.1.
and carried out in hospitalized pregnant women, defined by
the OLNUT tool.4, which investigates four categories to
establish nutritional risk: implications of clinical diagnosis on
nutritional status, changes in food intake, classification by
pregestational BMI, and classification of gestational
nutritional status.
The inclusion criteria were pregnant women hospitalized
with more than 10 weeks of gestation in the sexual and
reproductive health service by obstetrics and gynecology,
this inclusion criterion was adopted taking into account that
the nutritional classification by Atalah tables was
established.5It is possible to establish the gestational body
mass index as an indicator from the 10th week of pregnancy.
Women with multiple pregnancies or who at the time of the
inquiry did not accurately remember pre-gestational
anthropometric data were excluded.6.

The American Academy of Nutrition and Dietetics
establishes as key components of the nutritional care
process in pregnant women, adequate weight gain and a
healthy consumption of foods that allow meeting nutritional
requirements, with the aim of promoting proper health
status and reducing the risk of suboptimal fetal development
and chronic health problems in both the mother and the
child.2.
For the statistical analysis, the following variables were
included: clinical diagnosis (ICD-10), age, gestational week,
pregestational weight, gestational weight, height,
pregestational BMI, gestational BMI, nutritional status
classification by Atalah, and changes in food intake. For each
variable, the median, standard deviation (SD), and
frequencies in percentages were calculated. The statistical
analysis was carried out in the Excel program (Microsoft).

Adequate monitoring of nutritional aspects of the pregnant

woman is relevant to the extent that it allows us to avoid
Figure 1. Distribution of maltase enzymatic activity in
serious maternal accidents, reduce obstetric risks associated
the three intestinal sections, according to type of
with obesity in order to ensure harmonious fetal growth.3. treatment.
It is relevant to establish strategies that allow prioritizing
nutritional screening upon admission of the pregnant mother
to hospitalization, in order to detect risk factors derived from
the underlying pathology, inadequate food consumption,
weight and birth rate. pregestational mass and inadequate
body weight gain, in order to refer to nutritional treatment
as an integral part of the in-hospital nutritional care process.

The objective of this research was to evaluate the

nutritional risk of pregnant women hospitalized in a high-
level hospital, using the “OLNUT” nutritional screening tool in
pregnant women, which allows us to investigate four
aspects, the impact of clinical diagnosis. - unique in the
nutritional status of the pregnant woman, changes in food
intake, pre-gestational and gestational weight changes, in
order to establish the nutritional risk and define the
nutritional care plan.

METHODS
The present study is an observational, cross-sectional
cohort investigation carried out during the year.

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The present study is classified as low risk according to

resolution number 8430 of 1993 (October 4) by which the
scientific, technical, and administrative standards for health
research in the Republic of Colombia are established.
Nutritional screening is part of the institutional nutritional care
process, and aims to improve the health of pregnant women
and is aimed at achieving timely nutritional care.
RESULTS
Out of the total of 258 pregnant women screened with the
OLNUT tool, 194 patients (75.2%) were classified as having
high nutritional risk (Figure 1). In the present study, the
mean age of the population was 25.56 years, and the
gestational age was 24.5 weeks (Table 1).
At admission, it was evident that the most prevalent
diagnosis was Urinary Tract Infection, site not specified
present in 20.5% of pregnant women (Table 2). Regarding
the impact of the clinical diagnosis on the nutritional status
of the pregnant woman, during the year of screening
application, measured using the OLNUT tool, 45 (17.4%)
patients were classified as high-risk pregnant women in their
medical history, and 72 (27.9%) pregnant women in whom
the pathology could possibly be a factor leading to nutritional
and/or metabolic alterations; when comparing the
classification of pregestational and gestational BMI (Table 3),
it was evident that 38.8% of the population started
pregnancy with a state of malnutrition, which increased to
53.1% according to Atalah's classification at the time of
hospital admission, including 43 pregnant women with low.

Table 1. Characteristics of the population of hospitalized pregnant women screened nutritionally (n=258).

Feature Media Median Standard deviation

Mother's age (years) 25.6 24 8.7

Gestational age - LMP (weeks) at the time of nutritional screening 24.5 27 9.4

Height (m) 1.59 1.59 0.06

Pre-gestational weight (kg) 58.6 58 16.7

Current gestational weight (kg) 66.3 65 14.9

Pre-gestational BMI (kg/m2) 23.1 22.6 6.9

Gestational BMI (kg/m2) 26.9 27.3 5.5

Table 2. Clinical admission diagnoses.

ICD-10 Clinical diagnosis n %

N390 Urinary tract infection, site not specified 53 20.5

O140-141-149 Preeclampsia 13 5.0

O200 Threatened abortion 4 1.6

O210 Mild gravidic hyperemesis 8 3.1

O233 Infection of other parts of the urinary tract in pregnancy 9 3.5

O240 Preexisting insulin-dependent diabetes mellitus in pregnancy 1 0.4

O249 Unspecified diabetes mellitus in pregnancy 2 0.8

Z349 Supervision of unspecified normal pregnancy 26 10.1

Z359 Supervision of high-risk pregnancy, unspecified 7 2.7

Other diagnoses 135 52.3

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RIESGO NUTRICIONAL EN GESTANTES HOSPITALIZADAS

Table 3. Results of nutritional screening using OLNUT tool.

OLNUT Scale Criterion n %

Impact of clinical diagnosis on nutritional status

3 Definitely (High-risk pregnant woman) 45 17.4

2 Possibly 72 27.9

0 No 141 54.7

Changes in food intake

4 Yes. Recently decreased intake (only liquid consumption) 16 6.2

3 Yes. Recently decreased intake (incomplete solids) 72 27.9

Yes. Recently had a significant increase in food intake, greater than recommended for
2 26 10.1
pregnancy.

0 No changes. Adequate nutrition for gestational age. 144 55.8

Classification by pre-gestational BMI

4A BMI ≤ 18.4 Deficit 7 2.7

0 BMI 18.5-24.9 Normal 158 61.2

3 BMI ≥25- ≤29.9 Overweight 60 23.3

4B BMI > 30 Obesity 33 12.8

Classification of gestational nutritional status

4A Low Weight 43 16.7

0 Normal 121 46.9

3 Overweight 47 18.2

4B Obesity 47 18.2

weight (16.7%) and 94 (36.4%) pregnant women classified

as overweight and obese.
DISCUSSION
Currently, there are tools to categorize the nutritional
status of pregnant women5-7, however, there is a need to
establish screening and assessment tools for nutritional
status that not only take into account BMI classification, but
also factors such as those proposed by the OLNUT tool,
related to the impact of the disease on nutritional status and
changes in food intake that contribute to conditions such as
low weight, overweight, or obesity, instruments of minimal
complexity and time requirement for their application upon
admission to hospitalization of the pregnant woman.
That is why in this research it was decided to evaluate the
nutritional risk of pregnant women hospitalized in a high-
complexity hospital, using the "OLNUT" nutritional screening
tool, considering that several studies show how inadequate
nutritional status of pregnant women contributes to neonatal
morbidity and mortality and complications associated with
inadequate birth weight8-12.
Another relevant factor is the change in the pregnant
woman's diet, which was evidenced in 44.2% of the study
population. Langley-Evans.13highlight how the variation in
the quality or quantity of nutrients consumed by mothers
during pregnancy can have effects on programming and
become an important risk factor for non-communicable
diseases in adulthood.13.

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Authors like Bhutta, Das, et al 8, refer to the need for
interventions implemented on a large scale that demonstrate
the effectiveness of nutritional interventions in addressing
malnutrition and micronutrient deficiencies in pregnant
women, including community participation strategies,
promoting women's empowerment. jer, agriculture, food
systems, education, employment, social protection and
safety nets8.
CONCLUSIONS
The OL-NUT nutritional screening tool in pregnant women
allows for a simple way to establish the nutritional risk of
pregnant women, in order to provide timely nutritional care
within the framework of comprehensive health care, in a
group of patients who are of interest and priority for hospital
institutions and public health in a country.
ACKNOWLEDGEMENTS
To the research team of CIMED and the National
University of Colombia for promoting research for the benefit
of comprehensive patient management.
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