Weight management for improved pregnancy outcomes

摘要：从历史上看，营养不良一直是一个主要的健康问题。然而，最近， 在美国和其他国家，营养过剩也成为一个严重的公共卫生问题 工业化国家。随着新的肥胖症流行，我们看到发病率、死亡率、 和公共卫生负担，特别是在育龄妇女中。而病态的 肥胖在孕妇中一度很少见，在产科中的比例迅速上升 患者现在的肥胖水平大大增加了他们严重怀孕的风险。 并发症。这些并发症包括流产、死产的风险增加， 胎儿过大，导致剖腹产或母婴产伤 阴道分娩和新生儿死亡。在美国，超过三分之一的女性 美国人现在开始怀孕时体重指数为30或更高，这种情况 在50年前是罕见的。考虑到体重增加的严重后果 肥胖妇女在怀孕期间，如妊娠期糖尿病、先兆子痫或剖腹产 分娩，怀孕期间的最佳策略可能是保持稳定的体重，而不是 比增重15磅或更多要好。不幸的是，很少有关于它的有效性和 尽量减少孕期体重增加的可行性。这项研究旨在解决这一问题 有问题。200名怀孕时体重指数在30或更高的女性将被 被招募参加这个可行性测试。所有参与者都将是非营利性管理性医疗机构的成员 提供高质量产科护理的组织。自愿参加的患者将 被随机分配到体重维持干预或常规护理中。参与者 被分配到干预的人将参加一个旨在帮助 他们吃营养均衡的饮食，并控制能量摄入，以减少体重增加。 在她们怀孕期间。两组参与者(和他们的婴儿)都将参加以下活动- 在产后2周、产后6个月和产后一年进行评估。这个 主要的结果衡量标准将是母亲在怀孕期间的体重增加、体重 产后留存，且比例大，适合胎龄儿。次要的 结果将包括对母亲和她们的婴儿采取多种安全措施。除了……之外 安全措施，我们的二次分析将解决的可行性和可接受性 肥胖孕妇的体重管理干预。

ABSTRACT: Historically, under nutrition has been a major health concern. Recently however, over nutrition has also become a serious public health problem in the United States and other industrialized countries. With the new obesity epidemic we see increasing morbidity, mortality, and public health burden, particularly among reproductive-aged women. Whereas morbid obesity was once rare among pregnant women, a rapidly increasing proportion of obstetrics patients now have levels of obesity which dramatically increase their risk of serious pregnancy complications. These complications include increased risk of miscarriage, stillbirth, having a fetus that is too large leading to cesarean section or birth injuries for mom and baby from vaginal delivery, and death of the infant in the newborn period. More than 1/3 of women in the U.S. are now starting their pregnancies with a body mass index or 30 or greater, a condition that was unusual to rare 50 years ago. Given the serious consequences of added weight gain during pregnancy for obese women, such as gestational diabetes, pre-eclampsia, or cesarean delivery, the best strategy during their pregnancy may be to maintain a steady weight rather than gaining 15 pounds or more. Unfortunately, there is little research on the efficacy and feasibility of minimizing weight gain during pregnancy. This study is designed to address that problem. Two hundred women with BMIs of 30 or greater at the start of their pregnancy will be recruited for this feasibility test. All participants will be members of a non-profit managed care organization that provides high-quality obstetrics care. Patients who volunteer to participate will be randomly assigned to either a weight maintenance intervention or to usual care. Participants assigned to the intervention will participate in a weight maintenance program designed to help them eat a nutritionally balanced diet and to also control energy intake to minimize weight gain during their pregnancy. Participants (and their babies) in both groups will participate in follow- up assessments at 2 weeks postpartum, 6 months postpartum and one year postpartum. The primary outcome measures will be mothers' weight gain during pregnancy, the amount of weight retained after delivery, and the proportion of large for gestational age infants. Secondary outcomes will include multiple safety measures of the mothers and their babies. In addition to measures of safety, our secondary analyses will address the feasibility and acceptability of a weight management intervention among obese pregnant women.