DOI: 10.1590/1413-81232022271.

37782020 315

Socioeconomic and nutritional aspects of pregnant women

temas livres free themes

assisted by Programa Bolsa Família: cohort NISAMI

Aspectos socioeconômicos e nutricionais de gestantes

do Programa Bolsa Família: coorte NISAMI

Cinthia Soares Lisboa (https://orcid.org/0000-0001-7421-0746) 1

Jerusa da Mota Santana (https://orcid.org/0000-0002-8920-0097) 2
Maria Lúcia Silva Servo (https://orcid.org/0000-0003-4809-3819) 3
Ana Verônica Rodrigues Silva (https://orcid.org/0000-0002-3744-3652) 2
Djanilson Barbosa dos Santos (https://orcid.org/0000-0002-6128-1155) 2

Abstract The objective of this study was to eval- Resumo Objetivou-se avaliar os fatores socioeco-
uate the socioeconomic and nutritional assistance nômicos e de assistência nutricional de gestantes
factors of pregnant women who are beneficiaries beneficiárias do Programa Bolsa Família que fo-
of the Bolsa Família Program and were attend- ram atendidas em serviço de pré-natal em muni-
ed at a prenatal service in the city of Recôncavo cípio do Recôncavo da Bahia. Estudo transversal
da Bahia. A cohort study was conducted with 250 realizado com 250 gestantes do serviço de pré-
pregnant women from the prenatal service in 16 natal em 16 Unidades de Saúde da Família, de
Family Health Units from August 2013 to Decem- agosto de 2013 a dezembro de 2014. Para a coleta
ber 2014. A structured and previously tested ques- de dados, utilizou-se questionário fechado envol-
tionnaire was used to collect data. Socioeconomic vendo informações socioeconômicas, antropomé-
and nutritional variables were used. It was iden- tricas e de saúde da gestante. Identificou-se que
tified that the average age was 28.3 years, of these, a média de idade das gestantes foi de 28,3 anos,
85.2% studied until high school, 72.4% of preg- das quais 85,2% estudaram até o ensino médio,
nant women reported having income less than 72,4% das gestantes afirmaram possuir renda me-
or equal to two minimum wages, with a mean of nor ou igual a dois salários mínimos, com uma
1,036.3 and 26.8% reported receiving the benefit. média de 1.036,3 reais, e 26,8% declararam rece-
It was observed that 40% had a pre-gestational ber o benefício. Observou-se que 40% encontra-
Body Mass Index of overweight, 38% presented vam-se com Índice de Massa Corporal pré-gesta-
adequate weight gain for Gestational Age; 90.57% cional de excesso de peso, 38% apresentaram um
1
Programa de Pós- performed more than 7 consultations and 75.6% ganho de peso adequado para Idade Gestacional;
Graduação em Saúde reported that they made use of alcoholic beverag- 90,57% realizaram mais de 7 consultas, e 75,6%
Coletiva, Universidade
Estadual de Feira de Santana es or stopped in the gestation. The Bolsa Família relataram que fizeram uso de bebida alcoólica ou
(UEFS). Av. Transnordestina Program as an integrated strategy for social inclu- pararam na gestação. O Programa Bolsa Família,
s/n, Novo Horizonte. sion and economic development seems to have a enquanto uma estratégia integrada de inclusão
44036-900 Feira de
Santana BA Brasil. protective effect on the nutritional health of preg- social e de desenvolvimento econômico, parece
[email protected] nant women in the municipality. exercer efeito protetor na saúde nutricional das
2
Centro de Ciências da Key words Gestation, Social policy, Nutritional gestantes do município.
Saúde, Universidade Federal
do Recôncavo Baiano. Santo status, Prenatal care Palavras-chave Gestação, Política social, Estado
Antônio de Jesus BA Brasil. nutricional, Assistência pré-natal
3
Departamento de
Enfermagem, UEFS. Feira
de Santana BA Brasil.
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Lisboa CS et al.

Introduction to contribute to the discussion in this field, ap-

proaching nutritional and social determiners of
The gestation is a highly vulnerable life cycle due health care that directly influence the nutritional
to being associated with higher nutritional and status of pregnant women, taking into consider-
metabolic needs. In this period, many physical, ation the socioeconomic and nutritional factors
physiological, and psychological changes that of pregnant women from Recôncavo Baiano.
control maternal organic functions occur in the This research has shed light on peculiarities
organism to ensure the development of the fetus1. related to pregnancy in a region of Recôncavo
The inadequacy of maternal nutritional sta- Baiano, leading to outcomes that contribute to
tus in the gestational and pregestational period local managers responsible for health and social
constitutes a public health issue, as it leads to policies, in a context which this issue has drawn
the occurrence of gestational complications that the attention of Institutions and researchers, es-
negatively impact the course of the gestation. pecially those in the social epidemiology area, as
Both insufficient and excessive maternal weights well as public authorities.
are associated with gestational complications and Thus, this study aims to evaluate the socio-
adverse outcomes for both mothers and children. economic and nutritional assistance factors of
Among them is low weight at birth, macrosomia, pregnant women who are beneficiaries of the
prematurity, surgical birth, maternal diabetes, PBF who are attended in prenatal care in the mu-
and maternal hypertension2. nicipality of Recôncavo Baiano.
The weight gain of the pregnant woman, be-
ing adequate to the pre-gestational weight and
the gestational week, positively influences the Method
birth weight of newborns, because, according to
the International Statistical Classification of Dis- This is a cross-sectional research aligned to a dy-
eases and Related Health Problems - 10th Review namic prospective cohort study with pregnant
(ICD-10), children born alive weighing 2.500 women selected from the NISAMI cohort baseline
grams or less are considered to have an unsatis- - genetic and nutritional risk factors during gesta-
factory development3. tion associated with low weight at birth/prematu-
In this context, the nutritional assistance rity, enrolled in family health care units named
during the gestation is essential for monitoring Unidades de Saúde da Família (USF) from Santo
maternal nutritional status, as well as specific Antônio de Jesus, Bahia.
dietetic orientations for clinical, social, and eco- The municipality has 21 USFs, from which
nomic conditions of every pregnant woman as- 16 are in the urban area, included in the study.
sisted in the prenatal services4. The other 5 USFs were considered ineligible to
The socioeconomic factors are considered compose a sample for being located in neighbor-
social determiners of health. Among them are hoods of difficult access – or situated in the ru-
education level, sociodemographic status, skin ral zone – due to the insufficiency of human and
color, occupation, physical exercise level, caloric economic resources.
diet, parity, smoking, alcohol consumption, and The data of this research were collected
prenatal care5. through interviews with clinically healthy adult
In the spectrum of economic aspects as a pregnant women, residing and domiciled in the
determining factor in nutritional status, the Bra- urban area, and enrolled in the prenatal service
zilian social welfare program named Programa at a USF, from August 2013 to December 2014.
Bolsa Família (PBF) is relevant as a program of Women with twin pregnancy, teenagers, and oth-
conditioning income transfer, aiming to fight ers with Human Immunodeficiency Virus (HIV)
poverty and hunger and to promote food and were considered ineligible to compose a sample.
nutritional security6,7. In order to be continu- Thus, this research had the collaboration of
ously supported by this program, the beneficiary 250 pregnant women. This sample was calculat-
families need to fulfill the conditions related to ed based on the overweight prevalence of 48.1%
education and health care, especially the latter, among pregnant women residing in the city
which is demanded continuous prenatal moni- where the study was conducted9, with a sampling
toring and attendance to diet and nutritional ed- error of 3% and a power of 90%10.
ucation activities8. During prenatal services, pregnant women
This study is relevant for public health, espe- have been invited to participate in the research.
cially for the mother-children group, once it aims Those who accepted signed a term of consent
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Ciência & Saúde Coletiva, 27(1):315-324, 2022

and answered a semi-structured questionnaire, quate – low weight and adequate weight – and (1)
covering topics such as socioeconomic, demo- Excessive Weight Gain]. The pregestational BMI
graphic, health and obstetric information, and ac- is categorized by [(0) Adequate and (1) Excessive
cess to social welfare programs. At that moment, Weight Gain].
the pregnant women had their weight and height The enrollment in PBF and access to the ben-
assessed on the baseline. In a second stage, at the efits is the exposure variable of this study, cate-
end of the third trimester of pregnancy, the data gorized by [(0) Yes; (1) No]. Additionally, as co-
collection team returned to the prenatal service variates: maternal age [19 to 34; <19 and >34],
units to gather information from the patient’s family income [>2 Minimum Salaries; ≤2 Min-
medical records about weight along the period imum Salaries], education level [<High School;
of gestation and variables such as the number of ≥High School Diploma], alcohol consumption
prenatal consultations. [Not Consuming; Consuming but Quitting
A Filizola® model 31 mechanical scale with a during Gestation], number of prenatal consulta-
capacity of 150 Kg and a 100 g precision has been tions [≥7 Consultations; <7 Consultations], class
used to measure the maternal weight, and, for [class B and C; class A], parity [≥2; ≤2]; skin color
height measurement, a Sanny® stadiometer, hav- [not black; black], occupational status [active; not
ing a capacity of 200 cm and a 0.1 cm precision, active] and gestational trimester [first, second,
then recording both measures with its respective third].
replicate. The data from the baseline have been The Epi Info 6.04 b program has been used
collected by undergraduate students – about to for data digitalization, and the Data Analysis and
graduate in Nursing and Nutrition – previously Statistical Software (STATA) version 12 has been
trained by the project, and the data of the second applied for statistical analysis. Firstly, a descriptive
stage, by professionals from trained family health study has been conducted, in which proportions
teams. The research questionnaire undergone have been used for categorical variables and rate,
through two review steps after their completion, and standard deviation for continuous variables.
the former by the researchers themselves, and the Bivariate analysis has been undertaken among
latter, by the supervisors. independent variables (pre-gestational BMI, ges-
The gestational Body Mass Index (BMI) has tational weight gain, family income, education
been used as a proxy of the anthropometric status level, maternal age, prenatal consultations and
of pregnant women, classified according to the alcohol consumption) and the outcome variable
Atalah curve. The difference of weight between (Bolsa Família Program), measuring the gross
the last trimester of gestation and the pregesta- prevalence ratio (PR), along with its respective
tional phase has been defined as a parameter for confidence index (CI) of 95%. In statistical mod-
weight gain and classified based on the recom- eling, the variables present values of p<0,200. In
mendations of IOM (2009)11. the bivariate analysis, the Regression of the Pois-
The number of prenatal consultations, the son model has been introduced with considerable
Ministry of Health recommends that at least 06 variation. Variables that present values of p<0,05
prenatal follow-up consultations be carried out, have been kept in the model after adjustments us-
preferably one in the first trimester, two in the ing covariables. PR and CI95% estimations have
second and three in the second and third trimes- been eventually obtained.
ter of pregnancy12. For identification of measurement and con-
In order to classify the pre-gestational nutri- founding factors, a stratified analysis has been
tional status, the IOM-2009 applies the BMI ob- conducted with estimations for each covariable,
tained through the collected weight and height in having CI95%. The covariables that present out-
the 1º trimester of gestation, and then classifies comes p≤0,05 in the intuitive model have been
the pregnant women in low weight (BMI<18,5 considered effect modifiers and through Breslow-
kg/m²), appropriate weight (18,5≤BMI≤24,9 kg/ Day Test, comparing the saturated model to the
m²), overweight (25,0≤BMI≤29,9 kg/m²) and reduced model. The variables that present rel-
obesity (BMI≥30 kg/m²). Therefore, the meth- ative differences between the adjusted measures
od recommends adequate weight gain of 12,5 of each covariable and the gross association mea-
kg to 18 kg for pregnant women classified as low sures higher or equal to 20% have been consid-
weight; 11,5 kg to 16,0 kg for those classified as ered confounding variables.
appropriate weight; 7,0 to 11,5 kg for overweight This research was approved by the Ethics
group; and 5,0 to 9,0 kg for obesity group. Commission of Faculdade Adventista de Fisiote-
In this study, the weight gain during gestation rapia da Bahia (under the CAAE identifier code:
is an outcome variable categorized by [(0) Ade- 4369.0.000.070-10) in 2011.
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Lisboa CS et al.

Results It is relevant to enhance that the major PBF

holders are women, who take the responsibility
Table 1 shows the sociodemographic, nutritional and choice over the application of the resources
and gestational characteristics of the population to fight hunger and poverty12,13. Villatoro14, based
concerning this study. The characterization of on the World Bank studies, claims that when
the 250 pregnant women indicates that the av- the benefits are transferred to women, they take
erage age is 28.3 (SD=5.6), whom 84% studied more responsibility and capacity of negotiation,
until high school, having 9.9 average years of and assume the leading role in their families.
study (SD=2.8); 70.8% of pregnant women said The PBF is not only about a direct transfer-
their family income is lower than or equal to two ence of income to families, aiming to mitigate
minimum salaries, having an average income poverty in the short term, but it is also about the
of 1036.3 reals (SD=586.3), and 28.8% of them conditionalities that contribute to the access of
claimed to be beneficiary of governmental sup- the beneficiary women to health and education
port, specifically the PBF. services, hence contributing to improvements in
Regarding the anthropometric profiles of the health status, such as the increasing use of preven-
pregnant women, 40% had pregestational over- tion services, the improvement of immunization
weight, having an average of 25.8 Kg (SD=5.7), coverage, and encouraging healthy behaviors7,8.
and 64.8% had adequate weight gain concern- In this study, it has been observed that more
ing gestational age, having an average of 12.9 Kg than half of pregnant women fall into the age
(SD=4.9, Table 2), 85.6% had less than one child, group of 19-34, which is an adequate age group
84% were black, 54.8% were not active in terms for female reproduction since, in this stage, there
of occupational status and more than half (54%) is a minor risk for obstetric complications15.
were in the second trimester of pregnancy. When considering the education level, the
When considering the number of prenatal study shows that most of them accomplished
consultations, 68.8% reported more than seven. high school diploma. It is known that low edu-
Also, 75.6% said that they have consumed alco- cation level is related to infant mortality, growth
hol or quit during pregnancy. deficit, and sub nutrition. Additionally, pregnant
In the multivariate analysis adjusted by co- women have also a minor chance of accomplish-
variates (pregestational BMI, gestational weight ing more than six prenatal consultations and
gain, income, education level, maternal age, pre- more difficulties in following the vaccination
natal consultations, and alcohol consumption) calendar16. Thus, the educational profile of the
for the association between sociodemographic studied pregnant women can provide a signifi-
and nutritional characteristics according to the cant prognostic concerning the risks previously
PBF’s policies, these variables performed as pro- mentioned.
tector factors. The observed prevalence of ap- Among the conditionalities of this program,
propriate pregestational IBM is 19% (PR=0,19 the ones directed to the studied cycle stand out,
CI95%: 0,37-0,18) lower in pregnant women who which ensure the access of pregnant women to
are beneficiaries of PBF when compared to those prenatal and postpartum consultations and to
who are not. The beneficiaries present higher the participation of actions of food and nutrition
income (PR=0,69 CI95%: 0,58-0,83), undergo education in the primary health care network,
more prenatal consultations (PR=0,82 CI95%: especially in PSF12. However, 15.38% of benefi-
0,68-1,0) and quit alcohol consumption during ciaries had less than six consultations during pre-
gestation (PR=0,76 CI95%: 0,63-0,91) (Table 3). natal care.
According to Rasia and Albernaz17, despite
the progress related to the spread of prenatal ser-
Discussion vices in Brazil, it is possible to identify inequali-
ties in prenatal care services offered to pregnant
This study suggested that the PBF, as an integrat- women. Adverse socioeconomic conditions and
ed approach of social inclusion and economic lower school levels are the factors associated to
development, implies protector effects for the worse nutritional and health conditions – the
nutritional health of pregnant women. There- range of pregnant women that less search for
fore, the results show that the beneficiary wom- prenatal assistance, emphasizing how social in-
en have better nutrition and health conditions equality restrains access and leads to poor health
during gestation according to the variables con- care services, such as prenatal one, and enhanc-
sidered in this study. ing what claims the inverse care law18,19.
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Ciência & Saúde Coletiva, 27(1):315-324, 2022

Table 1. Sociodemographic, nutritional and gestational characteristics of pregnant women assisted in the Family
Health Units from Santo Antônio de Jesus district, Bahia, 2011.
Programa Bolsa Família
P-
Variables % No Yes
value*
N % N %
Maternal Age (years) 0,329
19 to 34 76 142 77,6 48 71,64
<19 and >35 24 41 22,4 19 28,36
Family Income 0,000
≤2 MS 72,4 119 65,03 62 92,54
>2 MS 27,6 64 34,97 5 7,46
Education Level 0,402
≥High School Diploma 85,2 158 86,34 55 82,09
<High School 14,8 25 13,66 12 17,91
Alcohol Consumption 0,148
Not Consuming 24,4 49 26,78 12 17,91
Consuming but Quitting during Gestation 75,6 134 73,22 55 82,09
Weight Gain 0,830
Adequate 38 68 37,16 27 40,3
Excessive Weight Gain 30,8 56 30,6 21 31,34
Low Weight 31,2 59 32,24 19 28,36
Pregestational BMI 0,222
Adequate 48,8 95 51,91 27 40,3
Excessive Pregestational Weight Gain 40 70 38,25 30 44,78
Low Weight 11,2 18 9,84 10 14,93
Number of Consultations 0,830
≥7 90,57 37 92,5 11 84,62
<7 9,43 3 7,5 2 15,38
Class 0,797
Class B and C 98,8 181 98,91 66 98,51
Class A 1,2 2 1,09 1 1,49
Parity 0,582
≥2 14,4 25 13,66 11 16,42
≤1 85,6 158 86,34 56 83,58
Skin color 0,237
Not Black 16 32 8,13 15 7,14
Black 84 106 91,87 97 92,85
Occupational Status 0,000
Active 45,2 100 58,4 26 32,11
Not active 54,8 80 41,6 44 67,88
Gestational Trimester 0,069
First 34,4 70 38,25 16 23,88
Second 54 91 49,73 44 65,67
Third 11,6 22 12,02 7 10,45
*Test chi-square. MS - Minimum Salary; BMI - Body Mass Index.
Source: Authors.

Regarding the monthly family income, most cant factor to expand the access to food for the
of the pregnant women reported having some entire family, and, therefore, an improvement in
equal to or lower than two minimum salaries, the nutritional health.
characterizing a low-income population. How- Other results related to the same population
ever, the PBF allowed the amplification of the demonstrate that beneficiary women include,
beneficiary income, revealing itself as a signifi- in their daily diet, the fundamental and healthy
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Lisboa CS et al.

Table 2. Sociodemographic and nutritional characteristics of pregnant women as beneficiaries and non-
beneficiaries of Programa Bolsa Família (PBF) from Santo Antônio de Jesus district, Bahia, 2011.
PBF Beneficiary
Characteristics Yes No
Average SD Average SD
Maternal Age 28,3 5,6 26,1 6,0
Years of Education 9,9 2,8 10,8 2,9
Family Income 1036,3 586,3 1672,6 1269,4
Pregestational BMI 25,8 5,7 23,8 4,2
Gestational Weight Gain 12,9 4,9 12,8 4,9
Prenatal Consultations 6,7 2,1 7,3 2,0
Source: Authors.

Table 3. Crude and adjusted analysis for the association between sociodemographic and nutritional
characteristics and access to the PBF benefit of pregnant women assisted in the Family Health Units from Santo
Antônio de Jesus district, Bahia, 2011.
Programa Bolsa Família
Variables N Crude Analysis Adjusted Analysis
PR CI95% PR CI95%
Maternal Age (years) 250 1,01 0,82-1,25 1,00 0,84-1,27
19 to 34
<19 and >35
Family Income 250 0,69 0,58-0,83 0,71 0,60-0,85
>2 MS
≤2 MS
Education Level 250 0,77 0,60-1,00 0,84 0,65-1,08
≥High School Diploma
<High School
Weight Gain 250 0,14 0,11-0,85 1,02 0,92-1,14
Weight Gain Adequate
Weight Gain Inadequate
Pregestational BMI 250 0,19 0,37-0,18 0,81 0,68-0,97
Adequate and Low Weight
Excessive Pregestational Weight Gain
Alcohol Consumption 250 0,76 0,63-0,91 0,78 0,65-0,95
Not Consuming
Consuming but Quitting during Gestation
Number of Consultations 250 0,82 0,68-1,00 0,82 0,68-0,99
≥7
<7
PR - Prevalence Ratio; CI95% - Confidence Interval of 95%; MS - Minimum Salary; BMI - Body Mass Index.

Source: Authors.

food group of the Brazilian population’s diet These results are similar to those found in a
(milk and its derivates, beans, meat, eggs, and study conducted in Porto Alegre17. It is import-
cereals), although low consumption of fruit and ant to stress that, in this present study, the family
vegetables has been also observed10. income of PBF beneficiary women is more than a
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Ciência & Saúde Coletiva, 27(1):315-324, 2022

minimum salary, and this program is associated tion accomplished more than seven consulta-
with the increase in family income, which might tions.
indicate a significant factor to expand the access Therefore, on the basis of researches, it is de-
to food for the entire family, and, therefore, an bated that the PBF encourages families to search
improvement in the nutritional health. for preventive health care, in which the basic
In this study, a higher adequate weight gain health services for the most vulnerable groups are
prevalence has been observed, which converges strengthened as a consequence of the PBF condi-
with other studies20,21. Thus, the nutritional as- tionalities, with positive effects in the health of
sistance during gestation must be performed to pregnant women and children12,32.
identify the maternal nutritional status, and to In this investigation, most of the pregnant
guide pregnant women’s diet according to the re- women have either consumed alcohol or quit
sult obtained in the assessment. during gestation. These outcomes meet the re-
Some studies suggest that, when assisted with sults in the studies performed by both Freire et
nutritional orientation, pregnant women en- al.33 in Rio de Janeiro and Havens et al.34, in the
hance their nutritional status, both low weight United States of America, in which the preva-
and overweight groups of pregnant women. In lence of alcohol consumption was 7.4% and
other words, changes in diet, among other fac- 10%, respectively.
tors, are related to the awareness of adequate nu- It is known that alcohol consumption leads
trition during pregnancy4,22. to complications also in maternal health, such as
Inadequacy of the maternal nutritional status cardiovascular disease, cancer, depression, and
in the pregestational and the gestational phases neurologic disturb. Moreover, it is related to in-
leads to gestational intercurrences that negative- sufficient gestational weight gain, lower number
ly affect the course of gestation23. Some of those of prenatal consultations, and increased risk of
intercurrences, such as variation in weight gain, consumption of other drugs35.
are associated with higher maternal and perinatal In Brazil, prenatal services have broad and
mortality rates, higher risk of abortion, prematu- significant coverage, revealing an ideal moment
rity, and low birth weight24. for intervention and prevention of the use of
The study performed in Porto Alegre record- substances harmful for mothers and children,
ed a high percentage of obese women among since, in this period, there is an intensification in
beneficiaries of PBF, which contrasts the out- the connection between the health professionals
comes of the present study, as the studied preg- and the pregnant women, ensuring, therefore,
nant women presented better control on weight better opportunities of intervention to occur36.
gain25,26. Alongside, in the research conducted in The authors acknowledge that the publica-
Recôncavo da Bahia with the same population, tions on this investigated topic is scarce, hence
the study identified that the PBF directly and it was a limitation for the development of this
negatively affects the pregnant women’s BMI research. Thus, the present study advances in
during gestation, indicating that they had lower the methodologic delineation and approach of
BMI during the gestational cycle10. the primary data. However, new studies must be
Recent studies have been demonstrating the performed, more extensive and with different ap-
positive impact of PBF in the maternal-infant proaches, in order to clarify the impacts that this
health condition and the reduction of infant social policy has been generating.
mortality27,28. The improvement of children’s Despite all methodological efforts applied to
health conditions and nutritional status was this study, some aspects inherent to the classifi-
expected as a positive impact of PBF, and the cation of variables may lead to limitations, illus-
scientific evidence of this has been widely regis- trated by the lack of standardization of BMI cut
tered10,12,29,30. points to the classification of pregestational an-
It is relevant to emphasize that, as condition- thropometric status, which might lead to differ-
ality of the program, both pregnant women and ences in outcomes among studies. However, this
nursing mothers must participate in both prena- study has followed the WHO standard (1995)11,
tal and postnatal consultations and activities of which has been the most applied standard, and
nutritional education31. In general, the literature researches from the scientific literature that uses
describes monitoring contributes to both mother the same cut point have been selected to make a
and fetus31. Thus, the PBF plays the role of pro- comparison of results.
tector to the mentioned variable. In other words, Based on the analyzed data, it is possible to
the beneficiary related to this present investiga- find evidence about the positive implications
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Lisboa CS et al.

that the PBF performs in this life cycle, suggest-

ing as a protector factor to the mother-fetus bi-
nomial, among other benefits, to provide better
nutritional attention, and to contribute to the ac-
tions of health promotion and prevention from
the risk factors.
Thus, they can contribute with subsidies to
the social policies directed to the improvement
of nutritional, health, and living conditions of
mothers and children of the most vulnerable
population in the country.

Collaborations

CS Lisboa contributed with the conception and

delineation of the study, data interpretation,
writing and critical revision of intellectual con-
tent. JM Santana and AVR Silva contributed with
the analysis and writing of the manuscript. MLS
Servo and DB Santos with the writing and revi-
sion of the manuscript. All authors read and ap-
proved the final manuscript.
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Ciência & Saúde Coletiva, 27(1):315-324, 2022

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Article submitted 25/02/2020

Approved 21/11/2020
Final version submitted 23/11/2020

Chief editors: Romeu Gomes, Antônio Augusto Moura da

Silva

CC BY This is an Open Access article distributed under the terms of the Creative Commons Attribution License