Management of obesity in pregnancy
Management of obesity in pregnancy
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DOI：
10.1097/01.aog.0000253311.44696.85
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发表时间：
2007-02-01
影响因子：
7.2
通讯作者：
Catalano, Patrick M.
中科院分区：
文献类型：
--
作者：
Catalano, Patrick M.
孕妇孕前肥胖是妊娠期不良结局的重要危险因素。在怀孕早期，自然流产和先天畸形的风险增加。在妊娠后期，代谢综合征的母体代谢表现，如妊娠期高血压疾病和糖尿病，由于肥胖妇女与非肥胖妇女相比胰岛素抵抗增加而在临床上得到确认。在患有孕前葡萄糖耐受不良、高血压、向心性肥胖和血脂紊乱的妇女中，妊娠期的生理变化增加了以前在妊娠期不常遇到的问题的风险。这些疾病包括慢性心功能不全、蛋白尿、睡眠呼吸暂停和非酒精性脂肪肝。分娩时，肥胖患者剖宫产的风险增加，并伴有麻醉、伤口破裂、感染和深静脉血栓性静脉炎等并发症。对于胎儿来说，存在巨大胎儿的短期风险，更具体地说是肥胖，以及代谢综合征的青春期成分的长期风险。虽然减肥手术的初步结果令人鼓舞，但手术费用昂贵，并不适用于所有肥胖妇女，我们认识到，缺乏对怀孕前接受减肥手术的肥胖妇女的后代的长期随访数据。在此期间，我们需要鼓励肥胖女性在怀孕前减肥，如果可能的话，改变生活方式。在怀孕期间，体重增加应限于医学研究所的指导方针（目前正在审查中），并鼓励进行体力活动。
Maternal pregravid obesity is a significant risk factor for adverse outcomes during pregnancy. In early pregnancy there is an increased risk of spontaneous abortion and congenital anomalies. in later gestation maternal metabolic manifestations of the metabolic syndrome, such as gestational hypertensive disorders and diabetes, become clinically recognized because of the increased insulin resistance in obese compared with nonobese women. In women with pregestational glucose intolerance, hypertension, central obesity, and lipid disorders, the physiologic changes in pregnancy increase the risk of problems previously not routinely encountered during pregnancy. These include chronic cardiac dysfunction, proteinuria, sleep apnea, and nonalcoholic fatty liver disease. At parturition the obese patient is at an increased risk of cesarean delivery and associated complications of anesthesia, wound disruption, infection, and deep venous thrombophlebitis. For the fetus there are short-term risks of fetal macrosomia, more specifically obesity, and long-term risks of adolescent components of the metabolic syndrome. Although preliminary results of bariatric surgery are encouraging, the procedure is expensive and not for all obese women, and we recognize that long-term follow-up data on offspring of obese women who have undergone bariatric surgery before pregnancy are lacking. In the interim, we need to encourage obese women to lose weight before conception, using lifestyle changes if possible. During pregnancy, weight gain should be limited to Institute of Medicine guidelines (currently under review) and encouragement given for physical activity.