Obesity, insulin resistance, and pregnancy outcome.
Obesity, insulin resistance, and pregnancy outcome.
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DOI：
10.1530/rep-10-0088
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发表时间：
2010-09
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影响因子：
--
通讯作者：
Catalano PM
中科院分区：
文献类型：
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作者：
Catalano PM
在过去几十年中，超重或肥胖的育龄女性数量显著增加。与消瘦或体重正常的女性相比，超重和肥胖女性胰岛素敏感性降低的风险增加。肥胖加上胰岛素敏感性降低，会增加这些人患代谢综合征以及相关的糖尿病、高血压、高血脂和心血管疾病问题的长期风险。由于正常妊娠期间的代谢变化，特别是胰岛素敏感性降低60%，超重和肥胖女性在妊娠期代谢失调的风险增加，即妊娠期糖尿病、子痫前期和胎儿过度生长。因此，妊娠可被视为对代谢综合征未来风险的一种代谢应激测试。在本章中，我们将回顾与这些疾病相关的潜在病理生理学。更重要的是，对这些风险的了解为预防提供了机会。例如，有计划的妊娠提供了在受孕前解决体重控制问题的机会。至少，通过避免在妊娠期体重过度增加，这可能防止产后体重过度滞留。最后，基于宫内编程的概念，这些生活方式措施不仅可能对女性自身有短期和长期的益处，对其后代也可能有益。
There has been a significant increase over the past few decades in the number of reproductive age women who are either overweight or obese. Overweight and obese women are at increased risk for having decreased insulin sensitivity as compared with lean or average weight women. The combination of obesity and decreased insulin sensitivity increases the long term risk of these individuals developing the metabolic syndrome and associated problems of diabetes, hypertension, hyperlipidemia and cardiovascular disorders. Because of the metabolic alterations during normal pregnancy, particularly the 60% decrease in insulin sensitivity, overweight and obese women are at increased risk of metabolic dysregulation in pregnancy, i.e. gestational diabetes, preeclampsia, and fetal overgrowth. Hence pregnancy can be considered a metabolic stress test for the future risk of the metabolic syndrome. In this chapter we will review the underlying pathophysiology related to these disorders. More importantly, an understanding of these risks provides an opportunity for prevention. For example, a planned pregnancy offers an opportunity to address weight control prior to conception. At the very least, by avoiding excessive weight gain during pregnancy, this may prevent excessive weight retention post partum. Finally based on the concept of in utero programming, these lifestyle measures may not only have short and long term benefits for the women but also for her offspring as well.