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[Anthropometric assessment of nutritional status in pregnancy: comparison of five diagnostic methods used in Latin AmericaClasificación antropométrica de las embarazadas: comparación de cinco métodos de diagnóstico utilizados en América Latina].

Objective
To determine the agreement between five anthropometric methods used for nutritional assessment in pregnancy and to compare the distribution of nutritional status obtained with each method to that of the population of non-pregnant young women in Brazil.


Method
This is a cross-sectional study with data from 1 108 pregnant women aged 19 to 35 years who received prenatal care from September 2011 to April 2012 in health services in the state of Pernambuco, Brazil. Nutritional status (underweight, appropriate weight, overweight/obesity) was determined using the criteria of Mardones and Rosso, Mardones et al., Atalah et al., Centro Latino Americano de Perinatologia (CLAP), and the Institute of Medicine (IOM-2009). Kappa agreement was estimated for the pairs of methods, and the chi-square goodness of fit test was performed to compare the frequency distribution of each nutritional category in each of the methods in comparison to the distribution in non-pregnant women classified according to body mass index (BMI, WHO cut-off points).


Results
Agreement between the methods was observed for overweight/obesity (kappa > 0.60), but not for underweight (kappa ≤ 0.60), particularly in the comparison of IOM-2009 (which relies on prepregnancy BMI) with other methods. The frequency distributions obtained with the five methods showed lower percentages of overweight/obesity and higher percentages of underweight as compared to the reference population of non-pregnant women (P < 0.001).


Conclusion
The disparities observed in the present study may have resulted from the heterogeneity among the methods. This suggests that additional surveys are needed to establish population-specific anthropometric standards.