Evidence-based recommendations for energy intake in pregnant women with obesity
Evidence-based recommendations for energy intake in pregnant women with obesity
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DOI：
10.1172/jci130341
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发表时间：
2019-11-01
影响因子：
15.9
通讯作者：
Redman, Leanne M.
中科院分区：
文献类型：
--
作者：
Most, Jasper;St Amant, Marshall;Redman, Leanne M.
背景在肥胖的女性中。妊娠期体重增加过多（>= 270 g/周）发生在三分之二的妊娠中，并导致母亲和婴儿的代谢损伤。为了改善产科护理，迫切需要客观评估能量平衡的信息。本研究的目的是描述肥胖妇女妊娠期体重增加的决定因素。这是一项针对肥胖孕妇的前瞻性观察性研究。主要结果是通过能量摄入平衡法计算的能量摄入。在妊娠早期（13-16周）和晚期（35-37周），通过双标记水和全室间接量热法测量能量消耗，通过空气置换体积描记法和同位素稀释法测量身体组成作为三室模型。在肥胖孕妇（n = 54）中，当能量摄入比能量消耗少125 +/- 52 kcal/d时，在妊娠中期和妊娠晚期达到推荐的体重增加（n = 8，15%）。相比之下，体重过度增加的女性（67%）每天消耗的热量比消耗的多186 +/- 29千卡（P < 0.001）。能量平衡影响母体肥胖（推荐：-2.5 +/- 0.8 kg脂肪量;过量：+2.2 +/- 0.5;不足：-4.5 +/- 0.5; P < 0.001），但不影响胎儿生长。体重增加与人口统计学、活动、代谢生物标志物或饮食质量无关。我们估计，与妊娠早期的能量需求（34 +/- 53 kcal/d，P = 0.83）相比，妊娠中期和妊娠晚期推荐体重增加的能量摄入需求并没有增加。我们在这里提供了我们认为是第一个基于证据的建议，为肥胖孕妇的能量摄入。与目前的建议相反，能量摄入不应超过能量消耗。
BACKGROUND. In women with obesity. excess gestational weight gain (>= 270 g/week) occurs in 2 out of 3 pregnancies and contributes to metabolic impairments in both mother and baby. To improve obstetrical care, objectively assessed information on energy balance is urgently needed. The objective of this study was to characterize determinants of gestational weight gain in women with obesity.METHODS. This was a prospective, observational study of pregnant women with obesity. The primary outcome was energy intake calculated by the energy intake-balance method. Energy expenditure was measured by doubly labeled water and whole-room indirect calorimetry and body composition as a 3-compartment model by air displacement plethysmography and isotope dilution in early (13-16 weeks) and late (35-37 weeks) pregnancy.RESULTS. In pregnant women with obesity (n = 54), recommended weight gain (n = 8, 15%) during the second and third trimesters was achieved when energy intake was 125 +/- 52 kcal/d less than energy expenditure. In contrast, women with excess weight gain (67%) consumed 186 +/- 29 kcal/d more than they expended (P < 0.001). Energy balance affected maternal adiposity (recommended: -2.5 +/- 0.8 kg fat mass; excess: +2.2 +/- 0.5; inadequate: -4.5 +/- 0.5; P < 0.001) but not fetal growth. Weight gain was not related to demographics, activity, metabolic biomarkers, or diet quality. We estimated that energy intake requirements for recommended weight gain during the second and third trimesters were not increased as compared with energy requirements early in pregnancy (34 +/- 53 kcal/d, P = 0.83).CONCLUSION. We here provide what we believe are the first evidence-based recommendations for energy intake in pregnant women with obesity. Contrary to current recommendations, energy intake should not exceed energy expenditure.